Variability in response to warfarin: a prospective analysis of pharmacogenic & environmental factors (CP450)
There is great variability in the dosage requirement of Warfarin necessary to maintain the international normalized ratio (INR) within a target range. There remains little in the way of clinical information to guide best practice with regard to starting regimes for warfarin in community-based patients. The purpose of the study is to define genetic and environmental factors that determine variability in response to warfarin. The proposed outcome of the study will be the development of a clinically useful and practical algorithm to help clinicians individualise anticoagulant therapy. The potential benefits include improved safety and cost effectiveness of warfarin therapy, improved quality of life for patients and improved uptake of warfarin therapy for atrial fibrillation (AF).
Ethnic Echocardiographic Heart of England Screeening Study
Heart failure means your heart does not pump enough blood to meet all the needs of your body. Usually, this is because the heart muscle has been damaged usually due to myocardial infarction or heart attack. As more individuals survive their heart attack, they are more prone to heart failure. This is important because it is common, costly, disabling and deadly. Further, it is also treatable.
Currently we do not know how common, i.e. the prevalence, heart failure is amongst the Black and minority ethnic groups.
Aim of the study
First study in the UK to establish the community prevalence of heart failure amongst the South Asian, Black-African and Black-Caribbean groups.
Mrs Jaskiran Dhonsi - firstname.lastname@example.org
Birmingham Atrial Fibrillation Treatment in the Aged Study
Atrial fibrillation (AF) is a major independent risk factor for thromboembolic disease associated with a five-fold increase in the risk of stroke. It is particularly important in the elderly... Read full text...
JWF Mant, SH Richards, FDR Hobbs, DA Fitzmaurice, GYH Lip, ET Murray, MV Banting, K Fletcher et al.
Protocol for Birmingham Atrial Fibrillation Treatment of the Aged study (BAFTA): a randomised controlled trial of warfarin versus aspirin for stroke prevention in the management of atrial fibrillation in an elderly primary care population
BMC Cardiovascular Disorders 2003, 3:9
UPDATE: This landmark study has demonstrated that warfarin is twice as effective as aspirin in protecting against stroke in patients with atrial fibrillation aged 75 and over, whilst being equally as safe in terms of haemorrhagic side-effects.
Mant J, Hobbs FDR, Fletcher K, Roalfe A, Fitzmaurice DA, Lip GYH, Murray ET.
Warfarin versus aspirin for stroke prevention in an elderly population with atrial fibrillation (the Birmingham Atrial Fibrillation treatment of the Aged Study, BAFTA): a randomized controlled trial.
Birmingham Anticoagulation Model
The Department of Primary Care and General Practice at the University of Birmingham has led the way in developing a model for oral anticoagulation treatment (OAT) in a primary care setting. Trials demonstrated that the use of computerised decision support systems (CDSS) and near-patient (NPT) for INR measurement offers the way into warfarin management in primary care. Read full text...
Oppenkowski T, Murray ET, Sandhur H, Fitzmaurice DA.
External quality assessment for warfarin dosing using computerised decision support software
J Clin Path 2003; 56: 605-607
Screening for Atrial Fibrillation in the Elderly
Atrial fibrillation (AF) is a major risk factor for stroke. This risk can be reduced through treatment with antithrombotic therapy, with a risk reduction of up to 68% observed with warfarin therapy. Guidelines for treatment of AF recommend ages 65 years and over as an indication for treatment with antithrombotic therapy in the presence of AF. This raises the question of whether screening for AF would be a useful policy, and if so what would be the best method for screening. Read full text...
Hobbs FDR, Fitzmaurice DA, Mant J, Murray E, Jowett S, Bryan S, Raftery J, Davies M, Lip G.
A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study.
Health Technology Assessment 2005; 9(40):1-90
UPDATE: This Department of Health funded study has demonstrated unequivocally that screening for atrial fibrillation significantly increases the detection of this important condition, and perhaps surprisingly, that opportunistic screening, using pulse palpation followed by ECG, is the most cost-effective screening option.
Fitzmaurice DA, Hobbs FDR, Jowett J, Mant J, Murray ET, Holder R, Raftery JP, Bryan S, Davies M, Lip GYH, Allan TF.
Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial.
BMJ 2007;335:383, doi:10.1136/bmj.39280.660567.55 (published 2 August 2007)
SAFE Companion paper
This SAFE companion paper has demonstrated that, whilst computerised diagnostic software performs better than primary care health professionals in diagnosing atrial fibrillation, in order to ensure a definitive diagnosis a consultant cardiologist needs to report on a 12 lead ECG.
Mant J, Fitzmaurice DA, Hobbs FDR, Jowett S, Murray ET, Holder R, Davies M, Lip GHY.
Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial.
BMJ 2007;335: 380, doi:10.1136/bmj.39227.551713.AE (published 29 June 2007)
Self-management of Anticoagulation: A Randomised Trial
Objective: To determine the clinical effectiveness of self management compared with routine care in patients on long term oral anticoagulants. Read full text...
D A Fitzmaurice, E T Murray, D McCahon, J P Raftery, S Hussain, H Sandhar, F D R Hobbs
Self management of oral anticoagulation: randomised trial