Cardiovascular — Sub-theme 1: Acute Vascular Syndromes:

Acute Coronary Syndromes (ACS), Acute Ischaemic Stroke (AIS), Subarachnoid Haemorrhage (SAH)

Sub-theme leads: Prof Robin Choudhury, Dr James Kennedy and Dr Rajesh Kharbanda

This research will result in major improvements in patient outcomes by increasing understanding of disease heterogeneity which will allow for timely treatments targeted to individual need. This is being achieved by systematic enrolment of patients [ACS (1000/yr) and AIS/SAH (500/yr)] into studies which follow patient groups over time. These studies are carrying out intensive phenotyping (characterisation) of the disease in patients. This is enabling development and application of new technologies in the Acute Vascular Imaging Centre (AVIC) that assess the crucial early pathways, often within the first minutes and hours of presentation, involving the blood, artery walls, brain and the muscular wall of the heart. Through a programme of hypothesis-driven clinical science, we are exploring how new diagnostic methods and treatments can be implemented into routine NHS care.

The sub-theme is developing and validating new diagnostic imaging strategies and blood biomarkers; we are working to understand how these respond to physiological and pharmacological manipulation, and translate these findings into early clinical trials and NHS care.

We also work on a programme of community-based research in applied ethics, addressing the challenges of enrolling patient with acute disease (that is illness that is severe and quickly comes to a crisis) into studies, particularly at a time when decision making by the patient is might be impaired.

Relevance of research to the health of patients and the public: By improving understanding of how to assess reperfusion (reintroduction of blood flow) in acute myocardial infarction/stroke, we can deliver it more effectively and improve outcomes. By testing treatments that can further reduce damage to the heart and brain we will be able to increase the benefits of reperfusion therapy. By using robust methods to test the effects of new drugs we can hasten their delivery into clinical practice. With our programme of community-based research in applied ethics, we are addressing the challenges of patient enrolment in the emergency setting, in particular those who may not be able to make sound decisions about their participation in a study.