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LIVES – AND WE NEED MORE OF THEM

Portsmouth researchers involved in study looking to prevent heart attack deaths

Around 30-40 people are brought to Queen Alexandra Hospital every month suffering a heart attack.

And now those patients are being offered the opportunity to take part in a high-profile clinical trial which could potentially change the future of heart attack treatment.

The £1.3m British Heart Foundation-funded clinical trial is looking at whether the simple technique of inflating and deflating a blood pressure cuff on the patient’s arm during a heart attack can help reduce the damage to the heart and help recovery. This process is called remote ischaemic conditioning (or RIC for short).

During a heart attack damage can be caused to the heart muscle. For patients who present with a heart attack the most effective treatment for limiting that damage is primary angioplasty – a treatment that restores the blood supply to the heart muscle by widening blocked coronary arteries and inserting a small tube called a stent.

But researchers have found, in some smaller studies, that the simple and cheap blood pressure cuff method, when used alongside an angioplasty, can reduce the damage to the heart muscle.

If successful, the research could reveal a simple way to help prevent heart failure and improve the chances of survival after a heart attack, and may lead to a change in clinical practice. It may reduce the number of hospital admissions for heart failure in the longer term.

Ali Dana, Consultant Cardiologist and Principal Investigator for the trial at QA, said: “This is a very exciting and high profile study for us to be a part of. We were invited to join the study by the lead investigator at University College London.

“This is an area of research that I was interested in, from a basic science perspective, some 20 years ago when I was doing my PhD, and it has taken all this time to bring the findings in to the clinical arena. Now is the time to see whether it really works for patients or not – and if it does, our patients may potentially see significant benefits from this simple intervention.

"The idea is that inflating the blood pressure cuff around their arm and making the arm ischaemic (starved of oxygen) for short periods of time, will protect the heart and reduce the size of their heart attack. If you have a smaller heart attack you live longer, have a smaller chance of heart failure and you have a better long term prognosis.“

Since February this year, researchers at Portsmouth Hospitals NHS Trust, which runs Queen Alexandra Hospital, have recruited over 100 patients to the trial – making them one of the highest recruiting centres out of the 21 hospitals nationwide currently recruiting to the trial.

“Our recruitment success lies with our novel approach to this study,” said Dr Dana. “At the start of our involvement with this study we were only able to recruit patients in to the trial during office hours, when the research team were here. But we are a 24/7 service so it was only right that we ran the clinical trial in the same way. We approached the radiographers in the Cath lab, where all heart attack patients initially present, and encouraged them to take on the role of verbally assenting the patients and randomising them into the trial. We are now at the point that we are able to screen nearly every patient arriving at our unit and recruit 60-70 per cent of all heart attack patients in to the study.

“We owe our recruitment success to our amazing and enthusiastic teamwork within the cardiology department, including the interventionalists, Cath lab staff, radiographers and the research nurses and clinical trials assistant keeping on top of all the data entry.

“We now have 10 radiographers on the delegation log, actively participating in recruitment into the trial. Since they came on board we are going from strength to strength.

“As a team we are all very proud of our success, but it is only through the team work within the department that we have been able to achieve it, and be able to offer participation in this trial to the vast majority of our heart attack patients.”

The trial, called ERIC-PPCI, is being led by Professors Derek Hausenloy, Derek Yellon and Rajesh Kharbanda. The trial is being run by the Clinical Trials Unit at London School of Hygiene and Tropical Medicine. They will study 2,000 people who have had a heart attack from 30 UK hospitals. They will investigate if ‘conditioning’ the heart using the blood pressure cuff method reduces the damage caused to the heart muscle in a heart attack, and if it improves survival and prevents heart failure developing. They will combine their results with a trial running in parallel in Denmark, to make the findings even more powerful, so that 4,300 patients will be studied in all.

A 63-year-old woman from West Sussex, who is taking part in the study at QA, said: “I was at home when I got a really crushing pain in my chest and arm. I asked my husband to call an ambulance and I was brought to QA. When they mentioned the trial to me I agreed because there didn’t seem to be any major risk and also because I believe it’s hugely important – you can’t find out about new treatments unless you participate in research.”

For more information please contact Research Communications Officer Sophie.henderson@porthosp.nhs.uk, or by phone 023 9228 6000 x 5212

Posted on Wed, February 22 2017