Atrial fibrillation, Stroke prevention, Stroke risk stratification, Bleeding risk with anticoagulation, Health Psychology, Evidence synthesis.
The main emphasis of her work over the last 10 years has been atrial fibrillation, with two major themes: bleeding and stroke risk stratification and patient-centred research. Other research interests include cardiovascular epidemiology particularly hypertension, ethnic differences in cardiovascular disease, cardiac rehabilitation, and psychological responses to myocardial infarction, diabetes mellitus, and heart failure.
Bleeding risk stratification
Reducing the risk of bleeding-related complications for atrial fibrillation (AF) patients requiring oral anticoagulation to prevent stroke is one Dr Lane’s main interests. In collaboration with national and international colleagues she has helped to identify bleeding risk factors among AF patients and has derived a novel bleeding risk score. The HAS-BLED schema has been incorporated into major national and international guidelines for the management of atrial fibrillation. In addition, her ongoing work is validating the HAS-BLED schema in other AF cohorts and seeking to identify novel blood biomarkers which may further refine bleeding risk in the AF population.
Stroke risk stratification
She has also been involved in identifying ‘new’ risk factors for stroke among AF patients and in conjunction with national and international colleagues she has helped to refine stroke risk assessment, by devising the CHA2DS2-VASc schema. Her research has involved comparison of CHA2DS2-VASc with other contemporary stroke risk schemas in different cohorts of AF patients. This has lead to the incorporation of the CHA2DS2-VASc schema into national and international guidelines for the management of AF patients. The CHA2DS2-VASc schema allows the identification of truly low risk AF patients who may not require antithrombotic therapy, while oral anticoagulation is considered all other patients. This has led to a significant shift in clinical practice, in conjunction with the availability of novel oral anticoagulants with their improved safety profile.
One of her major interests is the patient and how they adapt to diseases/illnesses. Most recently, her research has focussed on AF patients. Patient perceptions and understanding of disease and its treatment, and identification of patient barriers to treatment are fundamental to their acceptance and adherence to therapy, which is particularly important in chronic treatments which also require lifestyle modification, such as AF patients requiring lifelong oral anticoagulation therapy. Recent research has employed both quantitative and qualitative methodology to explore the patient experience of AF and treatment. She was the lead investigator for a recently completed randomised controlled trial comparing an educational and behavioural intervention, based on psychological theory, with usual care to examine the impact of education on patients’ knowledge and perceptions of AF and its treatment, and anticoagulation control. On-going qualitative research is examining the patients’ experience of AF and OAC therapy, and physicians’ attitudes to AF and OAC prescription. She is also the Chief Investigator for the United Kingdom for the AEGEAN study, a phase IV study examining the impact of patient education on medication adherence for patients receiving one of the new oral anticoagulants. Previously, she has investigated psychological responses to myocardial infarction and heart failure.
As the principal investigator she has recently completed an NIHR Health Technology Assessment funded systematic review of the effects of combination antithrombotic therapy on vascular events in high-risk (post acute coronary syndromes and/or stent implantation) AF patients. She is also the co-applicant of two other NIHR Health Technology Assessment funded systematic reviews, one on the diagnostic and prognostic utility of tests currently available for the detection of aspirin resistance in patients with established cardiovascular and cerebrovascular disease and the other on the development and evaluation of a prognostic model and clinical decision rule to help decide on cessation of anticoagulant therapy in patients with idiopathic venous thromboembolism (VTE).