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1. EFFECT OF ANTIHYPERTENSIVE DEPRESCRIBING ON SERIOUS ADVERSE EVENTS, MORTALITY, AND CARDIOVASCULAR DISEASE: LONG-TERM FOLLOW-UP OF THE OPTIMISE RANDOMISED CONTROLLED TRIAL

Author

Sheppard, James, primary, Temple, Eleanor, additional, Wang, Ariel, additional, Smith, Anne, additional, Pollock, Stephanie, additional, Ford, Gary, additional, Hobbs, Richard, additional, Kenealy, Nicola, additional, Lown, Mark, additional, De Lusignan, Simon, additional, Mant, Jonathan, additional, Mccartney, David, additional, Payne, Rupert, additional, Williams, Marney, additional, Yu, Ly -Mee, additional, and Mcmanus, Richard, additional

Published
2024
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4. The feasibility of population screening for paroxysmal atrial fibrillation using handheld ECGs

Author

Mant, Jonathan, primary, Modi, Rakesh N, additional, Charlton, Peter, additional, Dymond, Andrew, additional, Massou, Efthalia, additional, Brimicombe, James, additional, Freedman, Ben, additional, Griffin, Simon J, additional, Hobbs, F D Richard, additional, Lip, Gregory Y H, additional, McManus, Richard J, additional, and Williams, Kate, additional

Published
2024
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9. Reliability of single-lead electrocardiogram interpretation to detect atrial fibrillation: insights from the SAFER Feasibility Study

Author

Hibbitt, Katie, primary, Brimicombe, James, additional, Cowie, Martin R., additional, Dymond, Andrew, additional, Freedman, Ben, additional, Griffin, Simon J, additional, Hobbs, FD Richard, additional, Lindén, Hannah Clair, additional, Lip, Gregory Y. H., additional, Mant, Jonathan, additional, McManus, Richard J., additional, Pandiaraja, Madhumitha, additional, Williams, Kate, additional, and Charlton, Peter H., additional

Published
2024
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11. QRS detection in single-lead, telehealth electrocardiogram signals: benchmarking open-source algorithms

Author

Kristof, Florian, primary, Kapsecker, Maximilian, additional, Nissen, Leon, additional, Brimicombe, James, additional, Cowie, Martin, additional, Ding, Zixuan, additional, Dymond, Andrew, additional, Jonas, Stephan, additional, Clair Linden, Hannah, additional, Lip, Gregory, additional, Williams, Kate, additional, Mant, Jonathan, additional, and Charlton, Peter H, additional

Published
2023
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12. The Use of Primary Care Big Data in Understanding the Pharmacoepidemiology of COVID-19: A Consensus Statement From the COVID-19 Primary Care Database Consortium

Author

Dambha-Miller, Hajira, Griffin, Simon J., Young, Duncan, Watkinson, Peter, Tan, Pui San, Clift, Ashley K., Payne, Rupert A., Coupland, Carol, Hopewell, Jemma C., Mant, Jonathan, Martin, Richard M., and Hippisley-Cox, Julia

Subjects
Medical research -- Methods, Medicine, Experimental -- Methods, Big data -- Usage -- Health aspects, Medical records -- Usage, Primary health care, Health, Science and technology
Abstract

The use of big data containing millions of primary care medical records provides an opportunity for rapid research to help inform patient care and policy decisions during the first and subsequent waves of the coronavirus disease 2019 (COVID-19) pandemic. Routinely collected primary care data have previously been used for national pandemic surveillance, quantifying associations between exposures and outcomes, identifying high risk populations, and examining the effects of interventions at scale, but there is no consensus on how to effectively conduct or report these data for COVID-19 research. A COVID-19 primary care database consortium was established in April 2020 and its researchers have ongoing COVID-19 projects in overlapping data sets with over 40 million primary care records in the United Kingdom that are variously linked to public health, secondary care, and vital status records. This consensus agreement is aimed at facilitating transparency and rigor in methodological approaches, and consistency in defining and reporting cases, exposures, confounders, stratification variables, and outcomes in relation to the pharmacoepidemiology of COVID-19. This will facilitate comparison, validation, and meta-analyses of research during and after the pandemic. Key words: big data; coronavirus; epidemiology; primary health care, INTRODUCTION Primary care big data refers to routinely collected anonymized general practitioner (GP) electronic health records that form large and complex longitudinal databases, often with hundreds of variables at an [...]

Published
2021
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13. An artificial intelligence–based model for prediction of atrial fibrillation from single-lead sinus rhythm electrocardiograms facilitating screening

Author

Hygrell, Tove, Viberg, Fredrik, Dahlberg, Erik, Charlton, Peter H, Kemp Gudmundsdottir, Katrin, Mant, Jonathan, Hörnlund, Josef Lindman, Svennberg, Emma, Hygrell, Tove [0000-0003-2936-9998], Viberg, Fredrik [0000-0001-9093-3303], Dahlberg, Erik [0000-0001-5142-6069], Charlton, Peter H [0000-0003-3836-8655], Kemp Gudmundsdottir, Katrin [0000-0001-5106-749X], Mant, Jonathan [0000-0002-9531-0268], Hörnlund, Josef Lindman [0000-0001-5786-1301], Svennberg, Emma [0000-0002-6413-0870], and Apollo - University of Cambridge Repository

Subjects
Aged, 80 and over, Artificial intelligence, Electrocardiography, Heart Conduction System, Physiology (medical), Atrial Fibrillation, Screening, Humans, Intermittent ECG, Cardiology and Cardiovascular Medicine, Algorithms, Aged
Abstract

Aims Screening for atrial fibrillation (AF) is recommended in the European Society of Cardiology guidelines. Yields of detection can be low due to the paroxysmal nature of the disease. Prolonged heart rhythm monitoring might be needed to increase yield but can be cumbersome and expensive. The aim of this study was to observe the accuracy of an artificial intelligence (AI)-based network to predict paroxysmal AF from a normal sinus rhythm single-lead ECG. Methods and results A convolutional neural network model was trained and evaluated using data from three AF screening studies. A total of 478 963 single-lead ECGs from 14 831 patients aged ≥65 years were included in the analysis. The training set included ECGs from 80% of participants in SAFER and STROKESTOP II. The remaining ECGs from 20% of participants in SAFER and STROKESTOP II together with all participants in STROKESTOP I were included in the test set. The accuracy was estimated using the area under the receiver operating characteristic curve (AUC). From a single timepoint ECG, the artificial intelligence–based algorithm predicted paroxysmal AF in the SAFER study with an AUC of 0.80 [confidence interval (CI) 0.78–0.83], which had a wide age range of 65–90+ years. Performance was lower in the age-homogenous groups in STROKESTOP I and STROKESTOP II (age range: 75–76 years), with AUCs of 0.62 (CI 0.61–0.64) and 0.62 (CI 0.58–0.65), respectively. Conclusion An artificial intelligence–enabled network has the ability to predict AF from a sinus rhythm single-lead ECG. Performance improves with a wider age distribution.

Published
2023

14. The feasibility of population screening for paroxysmal atrial fibrillation using hand-held electrocardiogram devices.

Author

Mant, Jonathan, Modi, Rakesh N, Charlton, Peter, Dymond, Andrew, Massou, Efthalia, Brimicombe, James, Freedman, Ben, Griffin, Simon J, Hobbs, F D Richard, Lip, Gregory Y H, McManus, Richard J, and Williams, Kate

Abstract

Aims There are few data on the feasibility of population screening for paroxysmal atrial fibrillation (AF) using hand-held electrocardiogram (ECG) devices outside a specialist setting or in people over the age of 75. We investigated the feasibility of screening when conducted without face-to-face contact ('remote') or via in-person appointments in primary care and explored impact of age on screening outcomes. Methods and results People aged ≥65 years from 13 general practices in England participated in screening during 2019–20. This involved attending a practice nurse appointment (10 practices) or receiving an ECG device by post (three practices). Participants were asked to use a hand-held ECG for 1–4 weeks. Screening outcomes included uptake, quality of ECGs, AF detection rates, and uptake of anticoagulation if AF was detected. Screening was carried out by 2141 (87.5%) of people invited to practice nurse-led screening and by 288 (90.0%) invited to remote screening. At least 56 interpretable ECGs were provided by 98.0% of participants who participated for 3 weeks, with no significant differences by setting or age, except people aged 85 or over (91.1%). Overall, 2.6% (64/2429) screened participants had AF, with detection rising with age (9.2% in people aged 85 or over). A total of 53/64 (82.8%) people with AF commenced anticoagulation. Uptake of anticoagulation did not vary by age. Conclusion Population screening for paroxysmal AF is feasible in general practice and without face-to-face contact for all ages over 64 years, including people aged 85 and over. [ABSTRACT FROM AUTHOR]

Published
2024
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15. The feasibility of the PAM intervention to support treatment-adherence in people with hypertension in primary care: a randomised clinical controlled trial

Author

Kassavou, Aikaterini, Mirzaei, Venus, Shpendi, Sonia, Brimicombe, James, Chauhan, Jagmohan, Bhattacharya, Debi, Naughton, Felix, Hardeman, Wendy, Eborall, Helen, Van Emmenis, Miranda, De Simoni, Anna, Takhar, Amrit, Gupta, Pankaj, Patel, Prashanth, Mascolo, Cecilia, Prevost, Andrew Toby, Morris, Stephen, Griffin, Simon, McManus, Richard J., Mant, Jonathan, and Sutton, Stephen

Published
2021
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18. Statistical reanalysis of vascular event outcomes in primary and secondary vascular prevention trials

Author

Woodhouse, Lisa J., Montgomery, Alan A., Mant, Jonathan, Davis, Barry R., Algra, Ale, Mas, Jean-Louis, Staessen, Jan A., Thijs, Lutgarde, Tonkin, Andrew, Kirby, Adrienne, Pocock, Stuart J., Chalmers, John, Hankey, Graeme J., Spence, J. David, Sandercock, Peter, Diener, Hans-Christoph, Uchiyama, Shinichiro, Sprigg, Nikola, and Bath, Philip M.

Published
2021
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19. Longer-term efficiency and safety of increasing the frequency of whole blood donation (INTERVAL): extension study of a randomised trial of 20 757 blood donors

Author

Kaptoge, Stephen, Di Angelantonio, Emanuele, Moore, Carmel, Walker, Matthew, Armitage, Jane, Ouwehand, Willem H, Roberts, David J, Danesh, John, Thompson, Simon G, Donovan, Jenny, Ford, Ian, Henry, Rachel, Hunt, Beverley J, le Huray, Bridget, Mehenny, Susan, Miflin, Gail, Green, Jane, Stredder, Mike, Watkins, Nicholas A, McDermott, Alan, Ronaldson, Clive, Thomson, Claire, Tolkien, Zoe, Williamson, Lorna, Allan, David, Sambrook, Jennifer, Hammerton, Tracey, Bruce, David, Choudry, Fizzah, Ghvaert, Cedric, Jonston, Kirstie, Kelly, Anne, King, Andrew, Mo, Alfred, Page, Lizanne, Richardson, Penny, Senior, Peter, Umrania, Yagnesh, Wong, Henna, Burchell, Brendan, Gallacher, John, Murphy, Gavin, Newland, Adrian C, Wheatley, Keith, Greaves, Michael, Turner, Marc, Aziz, Tahir, Brain, Richard, Davies, Christine, Turner, Ruth, Wakeman, Paula, Dent, Alison, Wakeman, Alan, Anthony, Ben, Bland, Desmond, Parrondo, Willem H, Vincent, Helen, Weatherill, Candy, Forsyth, Andrea, Butterfield, Carol, Wright, Tracey, Ellis, Karen, Johnston, Kristie, Poynton, Pat, Brooks, Carolyn, Martin, Emma, Littler, Lara, Williamson, Lindsay, Blair, Donna, Ackerley, Karen, Woods, Lynn, Stanley, Sophie, Walsh, Gemma, Franklin, Gayle, Howath, Cheryl, Sharpe, Sarah, Smith, Deborah, Botham, Lauren, Williams, Caroline, Alexander, Claire, Sowerbutts, Gareth, Furnival, Diane, Thake, Michael, Patel, Shilpa, Roost, Carolyn, Sowerby, Sandra, Appleton, Mary Joy, Bays, Eileen, Bowyer, Geoff, Clarkson, Steven, Halson, Stuart, Holmes, Kate, Humphreys, Gareth, Parvin-Cooper, Lee, Towler, Jason, Addy, Joanne, Barrass, Patrica, Stennett, Louise, Burton, Susan, Dingwell, Hannah, Clarke, Victoria, Potton, Maria, Bolton, Thomas, Daynes, Michael, Spackman, Sarah, Walker, Michael, Momodu, Abudu, Fenton, James, King, Adam, Muhammad, Omer, Oates, Nicholas, Peakman, Tim, Ryan, Christine, Spreckley, Kristian, Stubbins, Craig, Williams, Joanna, Brannan, James, Mochon, Cedric, Taylor, Samantha, Warren, Kimberly, and Mant, Jonathan

Published
2019
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20. Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation

Author

Hoare, Sarah, Thomas, Gwilym PA, Powell, Alison, Armstrong, Natalie, Mant, Jonathan, Burt, Jenni, Hoare, Sarah [0000-0002-8933-217X], Thomas, Gwilym PA [0000-0001-7121-1743], Powell, Alison [0000-0003-2524-5357], Armstrong, Natalie [0000-0003-4046-0119], Mant, Jonathan [0000-0002-9531-0268], Burt, Jenni [0000-0002-0037-274X], and Apollo - University of Cambridge Repository

Subjects
sociology, interviews, screening, declining to participate, qualitative, atrial fibrillation, United Kingdom
Abstract

INTRODUCTION: While screening uptake is variable, many individuals feel they 'ought' to participate in screening programmes to aid the detection of conditions amenable to early treatment. Those not taking part in screening are often presented as either hindered by practical or social barriers or personally at fault. Why some people choose not to participate receives less consideration. METHODS: We explored screening nonparticipation by examining the accounts of participants who chose not to participate in screening offered by a national research trial of atrial fibrillation (AF) screening in England (SAFER: Screening for Atrial Fibrillation with ECG to Reduce stroke). AF is a heart arrhythmia that increases in prevalence with age and increases the risk of stroke. Systematic screening for AF is not a nationally adopted programme within the United Kingdom; it provides a unique opportunity to explore screening nonparticipation outside of the norms and values attached to existing population-based screening programmes. We interviewed people aged over 65 (n = 50) who declined an invitation from SAFER and analysed their accounts thematically. RESULTS: Beyond practical reasons for nonparticipation, interviewees challenged the utility of identifying and managing AF earlier. Many questioned the benefits of screening at their age. The trial's presentation of the screening as research made it feel voluntary-something they could legitimately decline. CONCLUSION: Nonparticipants were not resistant to engaging in health-promoting behaviours, uninformed about screening or unsupportive of its potential benefits. Instead, their consideration of the perceived necessity, legitimacy and utility of this screening shaped their decision not to take part. PATIENT OR PUBLIC CONTRIBUTION: The SAFER programme is guided by four patient and carer representatives. The representatives are embedded within the team (e.g., one is a co-applicant, another sits on the programme steering committee) and by participating in regular meetings advise on all aspects of the design, management and delivery of the programme, including engaging with interpreting and disseminating the findings. For the qualitative workstream, we established a supplementary patient and public involvement group with whom we regularly consult about research design questions.

Published
2023
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21. Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension

Author

Parati, Gianfranco, Stergiou, George S., Bilo, Grzegorz, Kollias, Anastasios, Pengo, Martino, Ochoa, Juan Eugenio, Agarwal, Rajiv, Asayama, Kei, Asmar, Roland, Burnier, Michel, De La Sierra, Alejandro, Giannattasio, Cristina, Gosse, Philippe, Head, Geoffrey, Hoshide, Satoshi, Imai, Yutaka, Kario, Kazuomi, Li, Yan, Manios, Efstathios, Mant, Jonathan, McManus, Richard J., Mengden, Thomas, Mihailidou, Anastasia S., Muntner, Paul, Myers, Martin, Niiranen, Teemu, Ntineri, Angeliki, O’Brien, Eoin, Octavio, José Andres, Ohkubo, Takayoshi, Omboni, Stefano, Padfield, Paul, Palatini, Paolo, Pellegrini, Dario, Postel-Vinay, Nicolas, Ramirez, Agustin J., Sharman, James E., Shennan, Andrew, Silva, Egle, Topouchian, Jirar, Torlasco, Camilla, Wang, Ji Guang, Weber, Michael A., Whelton, Paul K., White, William B., and Mancia, Giuseppe

Published
2021
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22. Progression of stroke risk in patients aged <65 years diagnosed with atrial fibrillation: a cohort study in general practice.

Author

Mendonça, Silvia C, Edwards, Duncan A, Lund, Jenny, Saunders, Catherine L, and Mant, Jonathan

Subjects
HEART failure, ATRIAL fibrillation, STROKE patients, MEDICAL record databases, DISEASE risk factors, ELECTRONIC health records
Abstract

Background: As a result of new technologies, atrial fibrillation (AF) is more likely to be diagnosed in people aged <65 years. Aim: To investigate the risk of someone diagnosed with AF aged <65 years developing an indication for anticoagulation before they reach 65 years. Design and setting: Population-based cohort study of patients from English practices using the Clinical Practice Research Datalink, a primary care database of electronic medical records. Method: The study included patients aged <65 years newly diagnosed with AF. The CHA2DS2-VASc score was derived at time of diagnosis based on patients' medical records. Patients not eligible for anticoagulation were followed up until they became eligible or turned 65 years old. The primary outcome of interest was development of a risk factor for stroke in AF. Results: Among 18 178 patients aged <65 years diagnosed with AF, 9188 (50.5%) were eligible for anticoagulation at the time of diagnosis. Among the 8990 patients not eligible for anticoagulation, 1688 (18.8%) developed a risk factor during follow-up before reaching 65 years of age or leaving the cohort for other reasons, at a rate of 6.1 per 100 patient-years. Hypertension and heart failure were the most common risk factors to occur, with rates of 2.65 (95% CI = 2.47 to 2.84) and 1.58 (95% CI = 1.45 to 1.72) per 100 patient-years, respectively. The rate of new diabetes was 0.95 (95% CI = 0.85 to 1.06) per 100 patient-years. Conclusion: People aged <65 years with AF are at higher risk of developing hypertension, heart failure, and diabetes than the general population, so may warrant regular review to identify new occurrence of such risk factors. [ABSTRACT FROM AUTHOR]

Published
2023
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24. Non-randomised feasibility study testing a primary care intervention to promote engagement in an online health community for adults with troublesome asthma: protocol

Author

Karampatakis, Georgios Dimitrios, primary, Wood, Helen E, additional, Griffiths, Chris J, additional, Taylor, Stephanie J C, additional, Toffolutti, Veronica, additional, Bird, Victoria J, additional, Lea, Nathan C, additional, Ashcroft, Richard E, additional, Day, Bill, additional, Coulson, Neil S, additional, Panzarasa, Pietro, additional, Li, Xiancheng, additional, Sheikh, Aziz, additional, Relton, Clare, additional, Sastry, Nishanth, additional, Watson, Jane S, additional, Marsh, Viv, additional, Mant, Jonathan, additional, Mihaylova, Borislava, additional, Walker, Neil, additional, and De Simoni, Anna, additional

Published
2023
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26. Wearable Photoplethysmography for Cardiovascular Monitoring

Author

Charlton, Peter, Kyriaco, Panicos A, Mant, Jonathan, Marozas, Vaidotas, Chowienczyk, Phil, Alastruey, Jordi, IEEE (Institute of Electrical and Electronics Engineers), Charlton, Peter H [0000-0003-3836-8655], Kyriaco, Panicos A [0000-0002-2868-485X], Mant, Jonathan [0000-0002-9531-0268], Marozas, Vaidotas [0000-0002-6879-5845], Chowienczyk, Phil [0000-0003-4507-038X], Alastruey, Jordi [0000-0003-3742-5259], Apollo - University of Cambridge Repository, and Charlton, Peter [0000-0003-3836-8655]

Subjects
QA75, cardiovascular, photoplethysmogram, wearable computers, photoplethysmogram (PPG), pulse wave, object recognition, smartwatch, biomedical monitoring, Cardiovascular (CV), sensor, reflectivity, optical variables measurement, photoplethysmography, Electrical and Electronic Engineering, signal processing, RA, signal processing algorithms, RC
Abstract

Smart wearables provide an opportunity to monitor health in daily life and are emerging as potential tools for detecting cardiovascular disease (CVD). Wearables such as fitness bands and smartwatches routinely monitor the photoplethysmogram signal, an optical measure of the arterial pulse wave that is strongly influenced by the heart and blood vessels. In this survey, we summarize the fundamentals of wearable photoplethysmography and its analysis, identify its potential clinical applications, and outline pressing directions for future research in order to realize its full potential for tackling CVD., This work was supported by British Heart Foundation grants [PG/15/104/31913] and [FS/20/20/34626], the University of Cambridge EPSRC Impact Acceleration Account, the Wellcome EPSRC Centre for Medical Engineering at King’s College London [WT 203148/Z/16/Z], the European COST ACTION-Network for Research in Vascular Ageing CA18216 supported by COST (European Cooperation in Science and Technology), and the European Regional Development Fund (project No. 01.2.2-LMTK- 718-01-0030) under a grant agreement with the Research Council of Lithuania (LMTLT). The authors acknowledge: financial support from the Department of Health through the National Institute for Health Research Cardiovascular MedTech Co-operative at Guy’s and St Thomas’ NHS Foundation Trust.

Published
2022

27. Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors

Author

Di Angelantonio, Emanuele, Thompson, Simon G, Kaptoge, Stephen, Moore, Carmel, Walker, Matthew, Armitage, Jane, Ouwehand, Willem H, Roberts, David J, Danesh, John, Donovan, Jenny, Ford, Ian, Henry, Rachel, Hunt, Beverley J, Le Huray, Bridget, Mehenny, Susan, Miflin, Gail, Green, Jane, Stredder, Mike, Watkins, Nicholas A, McDermott, Alan, Ronaldson, Clive, Thomson, Claire, Tolkien, Zoe, Williamson, Lorna, Allen, David, Sambrook, Jennifer, Hammerton, Tracey, Bruce, David, Choudry, Fizzah, Ghevaert, Cedric, Johnston, Kirstie, Kelly, Anne, King, Andrew, Mo, Alfred, Page, Lizanne, Richardson, Penny, Senior, Peter, Umrania, Yagnesh, Wong, Henna, Murphy, Gavin, Newland, Adrian C, Wheatley, Keith, Greaves, Michael, Turner, Marc, Aziz, Tahir, Brain, Richard, Davies, Christine, Turner, Ruth, Wakeman, Paula, Dent, Alison, Wakeman, Alan, Anthony, Ben, Bland, Desmond, Parrondo, Will, Vincent, Helen, Weatherill, Candy, Forsyth, Andrea, Butterfield, Carol, Wright, Tracey, Ellis, Karen, Poynton, Pat, Brooks, Carolyn, Martin, Emma, Littler, Lara, Williams, Lindsay, Blair, Donna, Ackerley, Karen, Woods, Lynn, Stanley, Sophie, Walsh, Gemma, Franklin, Gayle, Howath, Cheryl, Sharpe, Sarah, Smith, Deborah, Botham, Lauren, Williams, Caroline, Alexander, Claire, Sowerbutts, Gareth, Furnival, Diane, Thake, Michael, Patel, Shilpa, Roost, Carolyn, Sowerby, Sandra, Appleton, Mary Joy, Bays, Eileen, Bowyer, Geoff, Clarkson, Steven, Halson, Stuart, Holmes, Kate, Humphries, Gareth, Parvin-Cooper, Lee, Towler, Jason, Addy, Joanne, Barrass, Patricia, Stennett, Louise, Burton, Susan, Dingwall, Hannah, Clarke, Victoria, Potton, Maria, Bolton, Thomas, Daynes, Michael, Spackman, Sarah, Momodu, Abudu, Fenton, James, King, Adam, Muhammed, Omer, Oates, Nicholas, Peakman, Tim, Ryan, Christine, Spreckley, Kristian, Stubbins, Craig, Williams, Joanna, Brennan, James, Mochon, Cedric, Taylor, Samantha, Warren, Kimberley, and Mant, Jonathan

Published
2017
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30. Developing primary care services for stroke survivors: The Improving Primary Care After Stroke (IPCAS) research programme

Author

Mant, Jonathan, Mullis, Ricky, Mant, Jonathan [0000-0002-9531-0268], and Apollo - University of Cambridge Repository

Abstract

Background It is recognised that longer term needs after stroke are not well addressed by current services. The aim of this programme of research was to develop a novel primary care model to address these needs and to evaluate this new approach.

Published
2022
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35. What are the outcomes of dietary interventions in Heart Failure with preserved Ejection Fraction? A systematic review and meta-analysis.

Author

Forsyth, Faye, Mulrennan, Sandra, Burt, Jenni, Hartley, Peter, Kuhn, Isla, Lin, Helen, Mant, Jonathan, Tan, Sapphire, Zhang, Roy, and Deaton, Christi

Subjects
HYPERTENSION, CINAHL database, MEDICAL databases, VENTRICULAR ejection fraction, META-analysis, BODY weight, MEDICAL information storage & retrieval systems, SYSTEMATIC reviews, FUNCTIONAL status, ANTHROPOMETRY, LOW-carbohydrate diet, DIET therapy, TREATMENT effectiveness, DIETARY supplements, DESCRIPTIVE statistics, RESEARCH funding, DIETARY carbohydrates, MEDLINE, HEMODYNAMICS, HEART failure, DIETARY proteins, EVALUATION
Abstract

Aims To determine the efficacy of dietary interventions in Heart Failure with preserved Ejection Fraction (HFpEF). Method and results Keyword searches were performed in five bibliographic databases to identify randomized or controlled studies of dietary interventions conducted in HFpEF or mixed heart failure (HF) samples published in the English language. Studies were appraised for bias and synthesized into seven categories based on the similarity of the intervention or targeted population. The quality of the body of evidence was assessed via the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. Twenty-five unique interventions were identified; 17 were considered for meta-analysis. Most studies were judged to be at high risk of bias. There was moderate-quality evidence that caloric restriction led to clinically meaningful improvements in blood pressure and body weight. There was moderate-quality evidence that carbohydrate restriction resulted in meaningful reductions in blood pressure. There was very low-quality evidence that protein supplementation improved blood pressure and body weight and moderate-quality evidence for clinically meaningful improvements in function. Conclusions While some types of dietary interventions appeared to deliver clinically meaningful change in critical outcomes; the study heterogeneity and overall quality of the evidence make it difficult to make firm recommendations. Greater transparency when reporting the nutritional composition of interventions would enhance the ability to pool studies. Registration PROSPERO CRD42019145388. [ABSTRACT FROM AUTHOR]

Published
2023
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46. Why do people take part in atrial fibrillation screening? Qualitative interview study in English primary care

Author

Hoare, Sarah, Powell, Alison, Modi, Rakesh Narendra, Armstrong, Natalie, Griffin, Simon J, Mant, Jonathan, Burt, Jenni, SAFER Authorship Group, Hoare, Sarah [0000-0002-8933-217X], Powell, Alison [0000-0003-2524-5357], Modi, Rakesh Narendra [0000-0001-9651-6690], Armstrong, Natalie [0000-0003-4046-0119], Griffin, Simon J [0000-0002-2157-4797], Mant, Jonathan [0000-0002-9531-0268], Burt, Jenni [0000-0002-0037-274X], and Apollo - University of Cambridge Repository

Subjects
Stroke, primary care, Electrocardiography, Primary Health Care, cardiology, public health, Atrial Fibrillation, Humans, Mass Screening, Qualitative Research
Abstract

OBJECTIVES: There is insufficient evidence to support national screening programmes for atrial fibrillation (AF). Nevertheless, some practitioners, policy-makers and special interest groups have encouraged introduction of opportunistic screening in primary care in order to reduce the incidence of stroke through earlier detection and treatment of AF. The attitudes of the public towards AF screening are unknown. We aimed to explore why AF screening participants took part in the screening. DESIGN: Semistructured longitudinal interview study of participant engagement in the SAFER study (Screening for Atrial Fibrillation with ECG to Reduce stroke). We undertook initial interviews face to face, with up to two follow-up telephone interviews during the screening process. We thematically analysed and synthesised these data to understand shared views of screening participation. SETTING: 5 primary care practices in the East of England, UK. PARTICIPANTS: 23 people taking part in the SAFER study first feasibility phase. RESULTS: Participants were supportive of screening for AF, explaining their participation in screening as a 'good thing to do'. Participants suggested screening could facilitate earlier diagnosis, more effective treatment, and a better future outcome, despite most being unfamiliar with AF. Participating in AF screening helped attenuate participants' concerns about stroke and demonstrated their commitment to self-care and being a 'good patient'. Participants felt that the screening test was non-invasive, and they were unlikely to have AF; they therefore considered engaging in AF screening was low risk, with few perceived harms. CONCLUSIONS: Participants assessed the SAFER AF screening programme to be a legitimate, relevant and safe screening opportunity, and complied obediently with what they perceived to be a recommendation to take part. Their unreserved acceptance of screening benefit and lack of awareness of potential harms suggests that uptake would be high but reinforces the importance of ensuring participants receive balanced information about AF screening initiatives. TRIAL REGISTRATION NUMBER: ISRCTN16939438; Pre-results.

Published
2022

47. Cumulative complexity: a qualitative analysis of patients' experiences of living with heart failure with preserved ejection fraction.

Author

Forsyth, Faye, Blakeman, Thomas, Burt, Jenni, Chew-Graham, Carolyn A, Hossain, Muhammad, Mant, Jonathan, Sharpley, John, Sowden, Emma, and Deaton, Christi

Subjects
HEART failure risk factors, VENTRICULAR ejection fraction, INTERVIEWING, DISEASES, PATIENTS' attitudes, RISK assessment, QUALITATIVE research, INFORMED consent (Medical law), EMPLOYEES' workload, AGING, QUALITY of life, RESEARCH funding, MEDICAL case management, CARDIOVASCULAR disease nursing, THEMATIC analysis, HEALTH equity, PSYCHOLOGICAL distress, HEALTH self-care
Abstract

Aims To investigate how heart failure with preserved ejection fraction (HFpEF), within the context of limited clinical services, impacts patients' lives. Methods and results Secondary thematic analysis informed by the cumulative complexity model (CCM), of interview transcripts from 77 people diagnosed with HFpEF and their carers. Four themes corresponding to the core concepts of workload, capacity, access, and outcome described in the CCM were generated. Theme 1: Shouldering a heavy workload described the many tasks expected of people living with HFpEF. Theme 2: The multiple threats to capacity described how patients and carers strived to engage with this work, but were often faced with multiple threats such as symptoms and mobility limitations. Deficient illness identity (Theme 3) reflects how HFpEF either was not recognized or was perceived as a more benign form of HF and therefore afforded less importance or priority. These themes contributed to a range of negative physical, social, and psychological outcomes and the perception of loss of control described in Theme 4: Spiraling complexity. Conclusions The constellation of HFpEF, multi-morbidity, and ageing creates many demands that people with HFpEF are expected to manage. Concurrently, the same syndromes threaten their ability to physically enact this work. Patients' recollections of their interactions with health professionals suggest that there is a widespread misunderstanding of HFpEF, which can prohibit access to care that could potentially reduce or prevent deterioration. [ABSTRACT FROM AUTHOR]

Published
2023
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