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Coronary Heart Disease and Stroke in Scotland
8 Supporting Research and Development
Strategy Recommendation
CSO research portfolios for CHD and stroke should link with respective National Advisory Committee structures and with work being conducted on a national level by the Cardiovascular Research Funders' Forum, of which CSO is a member.
The Chief Scientist Office Portfolio Steering Group
8.1 A cardiovascular disease and stroke portfolio steering group (PSG) was established in September 2003 to inform the Chief Scientist Office (CSO) on how to secure best value from CHD and stroke research funds through a process of identifying gaps and opportunities. The Group is chaired by Professor David Webb of the University of Edinburgh. Membership covers a wide range of expertise in cardiovascular disease, stroke and diabetes research with representation across various medical and related disciplines.
8.2 As promised in the Strategy, this process will link with work being conducted at UK level by the Cardiovascular Research Funders' Forum and both the stroke and CHD National Advisory Committees are represented on the PSG. Where possible, research opportunities are viewed within the context of the UK portfolio of CHD and stroke research supported by major charity and public funders, as well as the perceived research strengths in Scotland. The work of the PSG has been influenced by the recent English initiative to create a UK Clinical Research Collaboration to manage clinical trials more effectively. Work is in train to establish an economical but effective model for Scotland that can engage successfully with research networks in England. The aim is to facilitate robust multi-centred research in Scotland and increase access of patients to novel treatments, in order to enhance patient care and outcomes. Participation in research will be widened to increase the number of NHS organisations, healthcare professionals and patients participating in both academic and industry led clinical trials. Members of the PSG, along with the British Heart Foundation, are currently pressing for the establishment of a cardiovascular disease research network.
8.3 The Group's early discussions focused on identifying opportunities to strengthen the present system. PSG members highlighted that the clinical research workforce was being limited significantly by bottlenecks at both the PhD and clinician scientist (post-doctoral) points in clinical research training. CSO is now working with industry and charities to explore the potential for partnership schemes to build capacity, whereby the Scottish Executive would fund project costs and the private or voluntary sector would meet the salary costs.
CASE STUDY
The Orkney Cardiovascular Disease Study (ORCADES) The Chief Scientist Office has recently provided funding for an Orkney-based study of the role of genetic factors in common diseases such as heart disease and stroke. The Orkney Cardiovascular Disease Study (ORCADES) is being led by Dr Jim Wilson of the University of Edinburgh. The study will include measurement of some well-established risk factors (such as blood pressure and cholesterol levels) as well as some newer measures of cardiovascular risk (such as pulse wave analysis) in approximately 1,000 people. The aims of the study are to identify the relative roles of inheritance and environment in determining the risk of disease and to identify regions of the genome contributing to this risk. Orkney has been chosen as the location of the study both because the stability of the population allows tracking of relationships and also because variation in environmental factors (such as diet and physical activity) is less than in many other populations. It is anticipated that the first results of the study will be available in 2007 and that they will contribute to the development of new approaches to preventing and treating cardiovascular disease. |
CASE STUDY
CLOTS Trial (Clots in Leg or TED after Stroke) The CLOTS study is a prestigious multi-centre international collaboration being led from Edinburgh that received support from the Chief Scientist Office for the start up phase and is now receiving funding from the Medical Research Council and Chest Heart Stroke Scotland. The project aims to resolve the present uncertainty over whether graduated compression stockings are useful for the prevention of post stroke deep vein thrombosis (DVT). CLOTS aims to find out whether: early and routine application of full length graduated compression (TED) stockings reduce the risk of above knee DVT in the weeks following an acute stroke full length graduated compression stockings are more effective than below knee stockings in reducing the risk of DVT
It estimated that around 5,500 patients will be involved in the study. For further information:
Email:
clots@skull.dcn.ed.ac.uk
Website:
www.clotstrial.com |
8.4 Developing capacity in primary prevention research was also identified as key to implementing primary prevention and access benefits from the wealth of research evidence on risk factors for CHD and stroke. Coincident with this, a National Prevention Research Initiative has been approved by a wide range of funders, including CSO. Funding of 10m over 5 years will be focused towards:
Clinical Research Facility
8.5 With a contribution from the Chief Scientists Office, Edinburgh's Clinical Research Facility (CRF) provides state of the art resources for clinical researchers from all specialities. The CRF incorporates the Wellcome Trust Clinical Research Facility at the Western General Hospital and the Royal Infirmary of Edinburgh Clinical Research Facility. The CRF is the only facility of its kind in Scotland, and offers access to a broad range of resources including high specification equipment, sample processing/storage facilities, clinical space and the support of highly skilled research nurses. The CRF also offers access to specialist support and expertise through its 5 departmental "core" areas: Epidemiology and Statistics; Integrative Physiology; Mass Spectrometry; Genetics; and Image Analysis. Researchers also have access to an education programme.
8.6 To date, 63 studies investigating cardiovascular themes (52 CHD & 11 stroke) have received approval to use the CRF. For example, Dr David Newby, Consultant Cardiologist and Director of the CRF, is developing a programme of cardiovascular research exploring vascular, endothelial and fibrinolytic function. This programme has used the resources of the CRF extensively and has led to several major international collaborations. Recent studies have characterised the adverse vascular effects of cigarette smoking and have led to one of the first demonstrations of the adverse cardiovascular effects of air pollution.
Scottish Intercollegiate Guideline Network CHD Guidelines
8.7 The Scottish Intercollegiate Guideline Network (SIGN) is undertaking a major review of the management of CHD related guidelines. They intend to publish a single, comprehensive guideline in 2005 to make it easier to apply evidence-based therapies in a connected and equitable way. The current evidence is being reviewed under five headings:
acute coronary syndromes
chronic coronary disease
heart failure
prevention
arrhythmias
8.8 Membership of the review groups is widely representative and includes contributions from patients, nurses and public health professionals. The British Heart Foundation and Chest Heart and Stroke are also represented.
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