Research

I am Director of the Liverpool Centre for Cardiovascular Science (LCCS), which is a research centre of excellence for the University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital. The LCCS mission statement is “Supporting the citizens of the Liverpool City Region to live healthier lives, free of cardiovascular diseases and stroke" and I have brought together a multidisciplinary group of academic (clinical/non-clinical) and NHS researchers into a truly cross-university, cross-department collaboration (‘research without boundaries’). The 5-year vision for LCCS to April 2025: “By 2025, LCCS will have improved cardiovascular disease and stroke outcomes, and transformed the strategic landscape for research & innovation, education and service in cardiovascular disease for Cheshire and Merseyside”

My own research work has delivered crucial impacts in changing national and international clinical practice guidelines and improvements in patient care within three principal areas: (i) treatment decisions related to stroke and bleeding risk in atrial fibrillation (AF), which is the commonest cardiac arrhythmia in the general population, (ii) screening practice in primary care, and (iii) stroke and bleeding risk assessment. These ultimately lead to reduced morbidity and mortality for a significant proportion of the population, particularly among the elderly.
I am recognised as having a global track record in AF research (https://expertscape.com/ex/atrial+fibrillation).

With regard to clinical management, clinical risk scores developed and validated by my work to assess stroke & bleeding risk in AF (ie. CHA2DS2-VASc & HAS-BLED) are used in national/international management guidelines, My development of SAMe-TT2R2 score (2013) aids decision-making between warfarin and new anticoagulants. This score is incorporated into ESC/NICE consensus recommendations, as well as AF patient pathways streamlining decision making (the ‘Birmingham 3-step’ AF pathway, 2016).
My ABC (Atrial fibrillation Better Care) pathway (2017/PMID:28960189) was first developed with stakeholder engagement (including patients, primary care, secondary care) and shown to reduce mortality/ hospitalisation/adverse outcomes (PMID:30551910, 30659810). The ABC Pathway is now recommended in international guidelines from European Society of Cardiology (PMID:32860505) and Asia-Pacific Heart Rhythm Society (PMID: 34773920).

Other recent health services research work in AF have included the analysis of NHS costs related to AF screening (PMID: 35138372) and projecting AF-related healthcare costs to the NHS (PMID: 35138372), as well as AF patient pathway mapping and stakeholder engagement (eg. PMID: 35999563, PMID: 36550397) and mixed methods (PMID: 35253141).

My other work has investigated incident AF risks (C2HEST score, identifying high risk patients for screening (PMID:31234697); used novel methodologies - machine learning (PMID:30615112) and mHealth/Apps: Huawei Heart Study and mAFA trial (PMID:31487545). We have recently completed the Supermarket/Hypermarket Opportunistic Screening for Atrial Fibrillation (SHOPS-AF) project in Liverpool (PMID: 35455694).

I am currently chief investigator for the Liverpool Heart And bRain Project (L-HARP) investigating the stroke-heart syndrome, given the high incident cardiovascular event rates in patients presenting with stroke (PMID: 35502192); also, the Liverpool-Huawei Stroke Study investigating smartwearables for AF detection post-stroke (PMID: 36493841).

I also have track record in translational research, hence providing an interface for early phase clinical studies and translational studies, well aligned with our successfully funded £5.3m Liverpool NIHR Clinical Research Facility (I am cardiovascular theme co-lead) and the AlderHey Children's NIHR CRF. I have designed and led multicentre multinational Phase II and III clinical trials and global registries, as PI or steering committee.

Highlights

Google Scholar profile; Publications on PubMed; AD Scientific Index Rankings

My research work has delivered crucial impacts in changing national and international clinical practice guidelines and improvements in patient care within three principal areas: (i) treatment decisions related to stroke and bleeding risk in atrial fibrillation (AF), which is the commonest cardiac arrhythmia in the general population, (ii) screening practice in primary care, and (iii) stroke and bleeding risk assessment. These ultimately lead to reduced morbidity and mortality for a significant proportion of the population, particularly among the elderly.

• I was selected to the Thomson Reuters Science Watch list of ‘World’s Most Influential Scientific Minds 2014’, a ranking of today’s top global 17 scholars who have published the greatest number of hot papers, ranked in the top 0.1% by citations, [issued June 2014]. In 2013, I was also selected to the Thomson Reuters Science Watch list of “Who and What was Hot in Scientific Reseach in 2012” (issued June 2013) which lists the most influential scientific researchers and research papers of the year.
• I am listed as Highly Cited Researcher [2014-2021], representing the top 1% most cited for their subject field [http://highlycited.com], the list of the world’s most influential scientists whose work has been consistently judged by their peers to be of particular significance, ie. being the top 1% most cited for their subject field and year of publication.
• In January 2014, I was ranked by Expertscape as the world's leading expert in the understanding and treatment of AF, and correspondingly, the University of Birmingham listed as the world's top institution for AF research [See https://bit.ly/3vGBjPt]. My global top ranking is still maintained in 2022: http://expertscape.com/ex/atrial+fibrillation]
• In June 2014, ranked by Expertscape as amongst the world's leading expert in the understanding and treatment of Hypertension [See https://bit.ly/3sJ4sYB]
• My work into improving AF clinical management won the Heart Rhythm UK ‘Arrhythmia Alliance Team of the Year Award 2012' and the BMJ Group ‘Cardiovascular Team of the Year 2013’ award
• May 2015, Founders Lecture Prize at the Heart Rhythm Society.
• 2016 National Institute for Health Research (NIHR) CRN West Midlands Clinical Research Impact award; for atrial fibrillation research, September 2016
• May 2016, Hungarian Society of Cardiology medal, Opening ceremony and Honorary Membership lecture, Annual Scientific Congress of the Hungarian Society of Cardiology, Balatonfüred
• May 2017: Royal College of Physicians of Edinburgh Sir Derrick Melville Dunlop medal - Keynote lecture in RCPE West Midlands Regional Symposium, 3rd May 2017.
• July 2017, West Midlands Academic Health Sciences Network Celebration of Innovation ‘Excellence in Wellness and Prevention Award’ Winner for “Birmingham 3 step approach” Prof GYH Lip/Dr S Sarwar: University of Birmingham and Sandwell and West Birmingham Hospitals NHS Trust.
• September 2017, Polish Cardiac Society medal and awarded honorary membership of the society. XXI International Congress of the Polish Cardiac Society - Katowice, Poland. Keynote State-of-the Art Lecture in the Zabrze-Birmingham Joint Symposium
• October 2017, Anticoagulation Achievement Awards ‘Centre best able to demonstrate adherence to NICE Quality Standards for Atrial Fibrillation’ for work on ‘Birmingham 3-step approach’ with Sandwell West Birmingham Clinical Commissioning Group; Also, Atrial Fibrillation Association (AFA) Healthcare Pioneers 2018 ‘Streamlining primary and secondary care management pathways for stroke prevention in atrial fibrillation.’
• March 2018 Conferred Honorary Fellowship of AIAC (Associazione Italiana Aritmologia e Cardiostimolazione) [FAIAC] “in consideration of … landmark contributions in the field of atrial fibrillation”
• In 2018, conferred Adjunct Professor, Yonsei University, Seoul, Korea; and honoured as Distinguished Professor by Aalborg University, Denmark [the first appointment for that University; inaugural lecture on 14 November 2018: https://www.youtube.com/watch?v=a9qj1geikPo
• October 2018: Bulgarian Cardiac Society medal and awarded honorary membership of the society.
• November 2018, Atrial Fibrillation Association (AFA) Healthcare Pioneers 2019 winner ‘An Integrated Approach To Streamline Atrial Fibrillation Management In A Holistic Manner: The ABC (Atrial fibrillation Better Care) Pathway; https://bit.ly/2zsxvDF)
• 2018: Listed in the ‘Top 1% in Field’ for the Global 2018 Peer Review Awards from Publons (ranked no 17 globally for Clinical Medicine https://bit.ly/2S8LDsH). Also, 2019, 2020 and 2021: Listed in the ‘Top 1% in Field’ for the Global Peer Review Awards from Publons
• March 2019: Conferred as Adjunct Professor, Seoul National University, Korea; and Visiting Professor, Medical University of Silesia in Katowice, Poland.
• April 2019: Finalist for the 2019 BMJ Awards ‘Cardiovascular and Stroke Team of the Year’
• July 2019: Winner 'Meridian Celebration of Innovation Award 2019’ from the West Midlands Academic Health Science Network, for the ABC pathway for AF management.
• October 2019: Heart Rhythm UK: Arrhythmia Alliance Award Outstanding Individual who has contributed to Arrhythmia Services ‘… for demonstration of excellence in their clinical practice or who have developed an innovative way of delivering care for patients …. adopted locally, regionally or nationally and that would ultimately benefit patients and their relatives.’
• August 2020: AIME 2020 Best Paper Nomination for “Towards Assigning Diagnosis Codes using Medication History” International Conference on Artificial Intelligence in Medicine: https://vbn.aau.dk/en/prizes/aime-2020-best-paper-nomination
• August 2021: European Heart Journal, Top Reviewer of the Year 2021.
• September 2021: Finalist for the 2021 BMJ Awards ‘Cardiovascular and Stroke Team of the Year’
• Conferred honorary doctorate by Medical University of Silesia in Katowice, Poland (Doctor Honoris Causa) 2021. Ceremony deferred due to COVID19 pandemic, to May 2023.
• February 2022: Hong Kong University Faculty of Medicine, Faculty Outstanding Research Output Award
• August 2022: European Heart Journal, Elite Reviewer of the Year 2022.
• Conferred honorary doctorate by University of Modena, Italy: Dottore Di Ricerca (Dott. Ric. or Ph.D) Honoris Causa in Clinical and Experimental Medicine, University of Modena: https://www.youtube.com/watch?v=xXBUznJhjps
• March 2023: Awards Committee and Board of Trustees of the American College of Cardiology: 2023 Distinguished Scientist Award (Clinical Domain) in recognition of major contributions to the advancement of scientific knowledge.
• March 2023: JACC 2022 Young Author Achievement Award, awarded to my research fellow Dr Jacopo Imberti and myself (as Mentor) at the 2023 American College of Cardiology Scientific Sessions in New Orleans, LA.

I am an investigator on the Wellcome Trust funded birth cohort Children Growing Up in Liverpool (C-GULL)

Example: Atrial fibrillation clinical management

With regard to clinical management, clinical risk scores developed and validated by my work to assess stroke & bleeding risk in atrial fibrillation (AF) (ie. CHA2DS2-VASc & HAS-BLED) are used in national/international management guidelines, eg. UK National Institute for Health & Care Excellence (NICE, 2006 & 2014), European Society of Cardiology (ESC 2012, 2016), Canadian Cardiovascular Society (2012), Asia Pacific Heart Rhythm Society (APHRS 2013, 2017), American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines (2014), American College of Chest Physicians (CHEST) guidelines, etc.

The CHA2DS2-VASc score helps clinicians formally assess stroke risk and identify `truly low risk' patients who do not need antithrombotic therapy, and effectively captures those patients who should be considered for stroke prevention. Risk assessment with CHA2DS2-VASc is part of the NICE Quality Outcomes Framework (QOF) and is easily available for use by GPs as part of the Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) risk stratification tool, available and compatible for use with all GP clinical systems in England. The simple, user-friendly HAS-BLED score, comprising risk factors either readily available from the clinical medical history or routinely tested in (new) patients, allows clinicians to formally assess bleeding risk, focusing on modifiable bleeding risk factors and those who require regular review (patients at higher bleeding risk).

My development of SAMe-TT2R2 score (2013) aids decision-making between warfarin and new anticoagulants. This score is used in the 2018 CHEST guidelines, ESC/NICE consensus recommendations, Clinical Commissioning Group (CCG) for AF (2014) and the PRIMIS Warfarin Patient Safety audit tool (2014). The CHA2DS2-VASc, HAS-BLED and the SAMe-TT2R2 scores are now part of the CCG AF patient pathway streamlining decision making and improving the primary-secondary care interface (the ‘Birmingham 3-step’ AF pathway, 2016). The latter forms the basis of the West Midland Academic Health Science Network (AHSN) ‘Preventing AF related Strokes’ initiative (2017), followed by Primary Care Clinical Pathway for Atrial Fibrillation Detection & Management issued by the WMAHSN and Public Health England https://bit.ly/2FhrwXQ). I proposed and validated an integrated and holistic approach to AF management as the ABC (Atrial fibrillation Better Care) pathway, which is adopted in the WMAHSN Primary Care Pathway, and used in the 2018 CHEST guidelines and 2018 Korean Heart Rhythm Society guidelines on AF management.
The ABC (Atrial fibrillation Better Care) pathway is central to the 2020 European Society of Cardiology (ESC) AF guidelines, and has been shown to reduce mortality/hospitalisation/adverse outcomes in patients with AF.

My overall clinical research work into AF has also had a major impact on recommendations in AF guidelines issued by NICE (2006 and 2014), as well as the ESC (2010, 2012, 2016 and 2020), CCS (2011) and ACCP (2012, 2018). My research has informed European consensus guidelines on the optimal management of anticoagulated AF patients who present with an acute coronary syndrome ± undergo coronary intervention/stenting (ESC, 2010, 2014, 2018), as well as the assessment/management of bleeding in AF patients (European Heart Rhythm Association (EHRA), 2011).

Example: The prothrombotic state in cardiovascular disease

The concept of ‘atrial fibrillation is a prothrombotic or hypercoagulable state’ was first proposed by myself in a Lancet article in 1996. Since then, I have investigated the mechanisms of thrombus formation in AF, focusing on various haemostatic and fibrinolytic factors, as well as platelets, in contributing to thromboembolism in AF. These aspects of my work are summarised in recent state of the art reviews. I have also described the various ‘drivers’ of the prothrombotic state in AF, including inflammation, growth factors, tissue factor pathway, extracellular matrix changes, etc. My pathophysiology work has led to use of biomarkers (eg. D-dimer) in the assessment and investigation of AF and its complications, as well as the study of new antithrombotic drugs by the pharmaceutical industry (various ongoing studies, since 2009), using surrogate biomarkers of clot formation in AF that were first described by my initial work. This has also been extended into understanding the mechanistic risks of bleeding and thromboembolism in AF patients with severe renal disease.

Research groups

Liverpool Centre for Cardiovascular Science (LCCS)

Research grants

Use of routinely collected electronic health record data to predict anti-microbial resistance in chronic P. aeruginosa lung infection

UK HEALTH SECURITY AGENCY - UKHSA (UK)

January 2023 - February 2024

Bench fees - MAJRASHI ABDULRAHMAN BISHI H. - 201731620

ROYAL EMBASSY OF SAUDI ARABIA CULTURAL BUREAU IN LONDON (UK)

October 2023 - September 2027

Improving the care of people with stroke using ‘big data’ from completed clinical trials (IMPROVE-Stroke)

THE DOWAGER COUNTESS ELEANOR PEEL TRUST (UK)

January 2024 - December 2024

AF Screening to Prevent Ischaemic StRokE (The ASPIRE Study) - The Role of Blood, ECG and Genetic Biomarkers

STROKE ASSOCIATION (UK)

April 2023 - March 2025

Bench fees for Bin Hashim (201709099)

MINISTRY OF HEALTH MALAYSIA (MALAYSIA)

April 2023 - March 2027