Global AF Reach

 

Global AF_banner2Atrial fibrillation (AF) is the most common heart rhythm disorder (arrhythmia) globally and is a major cause of morbidity and mortality - 25% of strokes are due to AF and adults have a 1 in 4 lifetime risk of developing AF. The main causes of AF (high blood pressure and diabetes) are common in low- & middle-income countries (LMICs). AF is often under-diagnosed and inadequately treated leading to missed opportunities in preventing fatal and disabling strokes. 

Awareness of AF is poor, a third of people with AF (more in LMIC settings) are unaware they have the condition and are not receiving life-saving treatment. Anticoagulation to stop clotting can be highly effective in reducing stroke occurrence. Warfarin, the most common anticoagulant, needs careful monitoring, but services for this are patchy. Newer direct oral anticoagulants are too expensive and care is rarely joined-up (ie integrated to include detection, anticoagulation and management of other conditions). 

The National Institute for Health Research (NIHR) Global Health Research Group on Atrial Fibrillation Management, University of Birmingham was formed in April 2018 and is led by Professors Gregory Lip and Neil Thomas. The research team in Birmingham has successfully led changes in AF management locally, in the UK, and in European countries with different healthcare systems by promoting stroke risk assessment and enabling clinicians to initiate oral anticoagulation in an integrated manner. 

The Directors have formed partnerships with three LMICs – Brazil, China and Sri Lanka. Using their knowledge and previous experience they plan to support the partners in these countries to develop tailored research to improve AF management with the aim of reducing AF-associated stroke which is common yet under-diagnosed or under-treated in these settings. 

 
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This research was commissioned by the National Institute of Health Research (NIHR) using Official Development Assistance (ODA) funding. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

About Global AF Reach

Global AF Reach is the NIHR Global Health Research Group on Atrial Fibrillation Management at the University of Birmingham.

Our aim is to foster research in LMIC healthcare and community settings to improve the diagnosis, management and prognosis of AF patients in low and middle income countries.

The Birmingham research team, with a track record in high quality research on screening practice in primary care and stroke and bleeding risk assessment and related treatment decisions, working with teams involved in AF healthcare in Brazil, China, and Sri Lanka have formed the Global AF Reach team. The team aims to co-develop the capability, networks and platform to deliver targeted and effective research and improve healthcare outcomes for people with AF in LMICs. 

Together we aim to:

• Develop and consolidate a sustainable collaboration and shared vision

• Strengthen community-based research culture and capacity to improve AF health outcomes through better AF understanding

• Adapt prioritised, evidence-based and sustainable pharmacological and behavioural approaches for integrated AF management according to cultural needs and the local healthcare infrastructure and assess the feasibility of their implementation

• Empower patients through development of culturally adapted, community-based approaches to increase education/awareness and to provide sufficient knowledge about AF and its complications for patients, families and health care professionals 

• Develop evidence-based local models of best care for policy makers to improve well-being of AF patients and provide a template for extending this work to other chronic conditions

• To build a sustainable research platform for future collaborations with the partner countries and other similar settings

Our Partners

We are working with 3 partner countries, Brazil, China and Sri Lanka.

The UoB research team will provide oversight, research method design and training.

The partner countries will be responsible for conduct and delivery of agreed research projects and linking with policy makers to embed findings into local services.

Brazil 

 

Brazil1

Brazil2

 

Paulo_A_Lotufo_profile

 

 

Professor Paulo A. Lotufo, Professor of General Internal Medicine at the Universidade de São Paulo Medical School (FMUSP) and Co-Director of the Center for Clinical and Epidemiologic Research. Professor Lotufo is Co- Principal Investigator of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Professor Lotufo is in charge of the Primary Care Program for undergraduate students and the General Internal Medicine rotation for undergraduate and medical residents. His research interests include cardiovascular and diabetes epidemiology.

Isabela_m_Bensenor_profile

 

 

Associate Professor Isabela M. Bensenor, Associate Professor of General Internal Medicine at the Universidade de São Paulo Medical School (FMUSP) and Co-Director of Center for Clinical and Epidemiologic Research. Dr Bensenor is Co- Principal Investigator of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). She was responsible for the implementation of teaching of primary care in the health units of the Health District of Butantã for undergraduate students and the General Internal Medicine rotation of undergraduate students and medical residents.

Rodrigo_Olmos_profile

 

 

Professor Rodrigo Olmos, Professor of General Internal Medicine, University São Paulo, Brazil. Professor Olmos works at the University Hospital of the University of São Paulo which is a secondary care hospital that has a strong interface with the primary health centres of the surrounding community. He teaches graduates as well as internal medicine and general practice residents mainly at the hospital outpatient clinic which serves as a general internal medicine reference to the General Practices in the western region of the city of Sao Paulo. 

China 

Li_Xuewen_profile

 

 

Professor. Li XuewenVice-president and Director of Cardiology , Shanxi DaYi Hospital, China. Professor Xuewen has medical experience on AF ablation, Pacemaker, and ICD implantation.

Feng_Mei_profile

 

 

Professor Feng Mei, Director of General Practice and Vice President of Shanxi Provincial GP Training and Research Center, Shanxi DaYi Hospital, Shanxi, China. Professor Mei majors in chronic disease management. She is also involved in the training programme for general practitioners in Shanxi, China.

Sri Lanka

 

SriLanka1

SriLanka2

 

 

Rajendra_Surenthirakumaran_profile

 

 

Dr Rajendra Surenthirakumaran(Suren), Senior Lecturer, Consultant in Family Medicine and Head of the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Sri Lanka. Dr Surenthirakumaren is a public health researcher and epidemiologist with a special interest in cost effective care for people with chronic diseases, especially in aging population and palliative care.

Ajini_Arasalingham_profile

 

 

Dr Ajini Arasalingam, Senior Lecturer in Medicine in the Faculty of Medicine at the University of Jaffna and Honorary Consultant Neurologist - Teaching Hospital Jaffna.  Dr Arasalingham's main research interest is in stroke & pharmacokinetics of neurological drugs.

Kumaran_Subaschandren_profile

 

 

Dr Kumaran Subaschandren, Lecturer in Family Medicine, Faculty of Medicine University of Jaffna, Sri Lanka, Family Physician at University Family Health Centre Divisional Hospital Kondavil, Sri Lanka and a Research Fellow (2017-2018), Institute of Applied Health Research, University of Birmingham, UK. Dr Subaschandran's particular interests are in identification and management of patients with chronic disease in primary care and health service research.

Research Projects

The research projects within the collaboration are currently being developed but it is planned to encompass four broad themes:

Theme one: Understanding the local ‘picture’ with regard to AF and its management

Theme two: Exploration of sustainable clinical approaches to improve AF management in local health care settings

Theme three: Use of behavioural interventions for improving AF management

Theme four: Economic impact and long-term cost effectiveness of approaches to AF management   

Investigators and Research Team

Directors

Gregory_Lip_profile

 

 

Professor Gregory Y.H. Lip, is Price-Evans Chair of Cardiovascular Medicine, at the University of Liverpool, UK – and Director of the Liverpool Centre for Cardiovascular Science at the University of Liverpool and Liverpool Heart & Chest Hospital.  He is an Honorary Professor in the Institute of Applied Health Research at the University of Birmingham.  Professor Lip is a NIHR Senior Investigator, as well as Distinguished Professor, Aalborg University, Denmark, and Adjunct Professor, Yonsei University, Seoul, Korea.

Half of his time is spent as a clinical cardiologist, and he practises the full range of cardiovascular medicine, including outpatient clinics (leading large atrial fibrillation and hypertension specialist services) and acute cardiology.

Professor Lip's major interest is the epidemiology of atrial fibrillation (AF), as well as the pathophysiology of thromboembolism in this arrhythmia.  Furthermore, he has been researching stroke and bleeding risk factors, and improvements in clinical risk stratification.  The CHA2DS2-VASc and HAS-BLED scores - for assessing stroke and bleeding risk, respectively – were first proposed and independently validated following his research, and are now incorporated into international guidelines.  

He was selected to the Thomson Reuters Science Watch list of ‘World’s Most Influential Scientific Minds 2014’, a ranking of today’s top 17 scholars who have published the greatest number of hot papers, ranked in the top 0.1% by citations, [issued June 2014; see website.  In 2014, Professor Lip was ranked by Expertscape as one of the world's leading experts in the understanding and treatment of AF 

Professor Lip was on the writing committee for various international guidelines, including the American College of Chest Physicians (ACCP) Antithrombotic Therapy Guidelines for Atrial Fibrillation, as well as various guidelines and/or position statements from the European Society of Cardiology (ESC) or EHRA. Specifically, he was also on the writing committees of the 2010 ESC Guidelines on Atrial Fibrillation, the 2012 ESC Focused Update Guidelines on Atrial Fibrillation, the 2012 ESC Guidelines on Heart Failure, and the 2014 NICE guidelines on AF.  He was Deputy Editor (“content expert”) for the 9th ACCP guidelines on antithrombotic therapy for AF (2012), and Chair of the new 2018 ACCP Guidelines on antithrombotic therapy for AF. 

Professor Lip has acted as senior/section editor for major international textbooks and at senior editorial level for major international journals, including Thrombosis & Haemostasis (Editor-in-Chief, Clinical Studies); Europace (Associate Editor); and Circulation (Guest Editor).

 Neil_Thomas_profile

 

Professor Neil Thomas, Professor of Epidemiology and Research Methods, and Director, Research and Knowledge Transfer at the Institute of Applied Health, University of Birmingham. Professor Thomas is also the Regional Director of the National Institute for Health Research (NIHR) Research Design Service for the West Midlands.  He has a multimillion pound global research portfolio focussing particularly on populations in Asia (e.g. Hong Kong, China, Iran) and Africa (e.g. Kenya, Ethiopia, Nigeria, Uganda) investigating the aetiology (particularly air pollution), prognosis, prevention and treatment of cardiometabolic disease, including Atrial Fibrillation. 

Co-applicants UK

Peter_Brocklehurst_profile

 

 

Professor Peter Brocklehurst, Professor of Women's Health and Director of the Birmingham Clinical Trials Unit at the University of Birmingham and Professor of Perinatal Epidemiology and Co-Director of the Policy Research Unit in Maternal Health and Care, at the National Perinatal Epidemiology Unit,  University of Oxford. Professor Brocklehurst's expertise is in RCTs and observational epidemiology. 

KK_Cheng_profile

 

 

Professor KK Cheng, Professor of Public Health and Primary Care and Director of the Institute of Applied Health Research, University of Birmingham. Professor Cheng is also Director of the General Practice Development and Research Center, Peking University Health Science Center.  He has been a Professor at the University of Birmingham since 1995. His main interests are in the epidemiology, prevention and control of important non-communicable diseases and the development of primary care in China.

Sheila_Greenfield_profile

 

 

Professor Sheila Greenfield, Professor of Medical Sociology at the University of Birmingham is a medical sociologist and qualitative methodologist. She is experienced in the design and implementation of qualitative research as a component of mixed methods research and the application of sociological theory. Previous and ongoing work has included the management and delivery of qualitative work across cross-cultural environments e.g. clinical handover (India); Prevention programme for Gestational Diabetes Mellitus (Pakistan); Yoga programme for type-2 diabetes prevention (India). Her major research interest is in the methods people use to self manage their health either for health promotion and prevention or for the management of diagnosed medical conditions.

Kate_Jolly_profile

 

 

Professor Kate Jolly, Professor of Public Health & Primary Care at the University of Birmingham. Professor Jolly's particular research interests are self-management and rehabilitation in patients with long-term conditions, including heart disease and the cultural adaptation of interventions.  She has experience of global research as co-investigator on the Birmingham COPD NIHR Global Health Group.

Sue_Jowett_profile

 

 

Dr Sue Jowett, Reader in Health Economics at the University of Birmingham. Dr Jowett's main research interests are applied economic evaluations, including evaluation alongside randomised controlled trials and the use of decision modelling, related to chronic disease prevention and treatment in a primary care setting. Her clinical areas of interest are cardiovascular, musculoskeletal and respiratory conditions and she has published health economic analyses of AF screening and treatment and anticoagulation management.

Paulus_Kirchof_profile

 

 

Professor Paulus Kirchhof, Professor of Cardiovascular Medicine at University of Birmingham and Director of the Institute of Cardiovascular Sciences. Professor Kirchof researches translational mechanisms and management of cardiovascular diseases with a special interest in atrial fibrillation and cardiomyopathies from mechanisms to clinical research. He runs a large atrial fibrillation service at Sandwell and West Birmingham Hospitals NHS trust and the interdisciplinary Inherited Cardiac Conditions Clinic at University Hospital Birmingham NHS trust.

Deirdre_Lane_profile

 

 

Dr Deirdre Lane, Reader in Cardiovascular Health at the University of Liverpool and Adjunct Professor of Cardiovascular Health at Aalborg University, Denmark.  Atrial fibrillation is Dr Lane's main research interest focused on bleeding and stroke risk stratification and patient-centred research.  She is a co-author of both the CHA2DS2-VASc stroke risk stratification score and the HAS-BLED bleeding risk score.  Her other main research interest is how AF affects quality of life and psychological well-being, patient education and patients’ perceptions of AF and medication adherence.  Dr Lane was the Chair for a European Heart Rhythm Association (EHRA) position document on ‘Cardiac tachyarrhythmias and patient values and preferences for their management’ and is a member of American College of Chest Physicians guidelines on antithrombotic therapy in AF patients.

Dan_Lassersson_profile

 

 

Professor Dan Lasserson, Professor of Ambulatory Care at the University of Birmingham. Professor Lasserson works in acute ambulatory medical care at the Queen Elizabeth Hospital and has previously worked in General Practice as well as hospital medicine. His research group tackles the challenge of meeting the growing need for delivery of acute medical care within increasingly constrained resources. His research programme includes mixed methods studies of point of care diagnostics, risk prediction, clinical decision making and patient and carer experience. He also leads the ‘Ageing, Frailty and Resilience’ development theme in the University’s Institute for Global Innovation with initial projects planned in Botswana and Brazil.

Trudie_Lobban_profile

 

 

Ms Trudie Lobban, founder and CEO of the Arrhythmia Alliance, a coalition of charities, patient groups, healthcare professionals, policymakers and industry representatives. Under her lead, the Alliance successfully lobbied for a new chapter on arrhythmia and sudden cardiac death to be included in the UK’s National Service Framework for Coronary Heart Disease on Arrhythmia’s. In 2007, Ms Lobban established the Atrial Fibrillation Association, which provides information, support, education and awareness to AF patients and healthcare professionals. 

Semira_Manesiki_Holland_profile

 

 

Dr Semira Manesiki Holland, Senior Clinical Lecturer in Public Health at the University of Birmingham with an interest in health systems, maternal-child health and low- and middle-income countries. Dr Holland is a UK based public health physician with a paediatric background and has worked in clinical medicine, health systems delivery and policy, public health and research in the UK and developing countries for over 20 years. Her low and middle-income country experience includes research (such as large community trials in challenging academic environments), work for WHO and UNICEF on country based programmes and at WHO HQ, with Ministries of Health to advise on strategy and policy development and at the CEO level in International Health Non-governmental Organisations (NGO) coordinating delivery of integrated health services (in Afghanistan and Tajikistan from village to provincial hospitals) and operations of training colleges.

David_Moore_profile

 

 

Dr David Moore, Senior Lecturer at the University of Birmingham, specialises in directing multidisciplinary teams of researchers undertaking systematic reviews, health technology assessments and associated research. He is co-Director of the MSc in Health Research Methods and a curriculum advisor and previous deputy director of the MSc in Public Health at the University of Birmingham. He leads a post-graduate taught module in Systematic Reviews and Evidence Syntheses and teaches systematic reviews and evidence synthesis at postgraduate and undergraduate level. 

 Krish85mmx85mm

 

Dr Krishnan Nirantharakumar (Krish), Senior Clinical Lecturer at the University of Birmingham. Dr Nirantharakumar has substantial experience in health informatics research (data science and implementation science) as the co-theme lead for health informatics at the Institute of Applied Health Research, University of Birmingham. His particular interests are in developing novel digital tools that enable efficient healthcare systems and expedite health care research. He is the founder of the West Midlands Health Informatics Network and innovator of the Automated Clinical Epidemiology Studies (ACES) tool. The latter innovation has led to a UKRI Innovation Fellowship with HDR UK. His long term mission is to lead a global health informatics team to improve the health and wellbeing of the disadvantaged communities in low and middle income countries.

Isabelle_Szmigin_profile

 

 

Professor Isabelle Szmigin, Professor of Marketing and Deputy Dean of Birmingham Business School at the University of Birmingham. Professor Szmigin's research interests lie in the area of conceptualising consumer behaviour and understanding the social and policy issues concerned with consumption. She has held a number of grants and most recently was Co-Investigator on an Alcohol Research UK Grant looking at alcohol marketing to young people via social media and its implication for advertising codes of practice.

Co-applicant Brazil

Gustavo_Gusso_profile

 

 

Professor Gustavo Gusso, Professor of General Practice, University of São Paulo, Brazil and a practicing family doctor. At the University of São Paulo he wrote and is the current coordinator of the residency program of family and community medicine as well as the rotation in family medicine for undergraduates. He has Master of Clinical Science in Family Medicine at University of Western Ontario, Canada and PhD in Medicine at University of São Paulo. He was coordinator of the National Strategy for Medical Education at Ministry of Health and president of Brazilian Society of Family and Community Medicine. He is the main editor of Brazilian Textbook of Family Medicine that won the most important scientific award at Brazil in 2013. Gustavo Gusso is currently editor of Brazilian Journal of Family and Community Medicine.

Co-applicant China

Yutao_Guo_profile

 

 

Associate Professor Yutao Guo, Associate Professor of Cardiology at the Chinese People’s Liberation Army General Hospital, Beijing, China. She is also a chief Physician, Division of Cardiology, Chinese PLA General Hospital. Her medical expertise is in arrhythmia, antithrombotic management, and cardiovascular disease  prevention.

Co-applicant Sri Lanka

Mahesan_Guruparan_profile

 

 

Dr Mahesan Guruparan, Consultant Cardiologist - Teaching Hospital Jaffna. Dr Guruparan is a general cardiologist involved in outpatient care as well as interventional cardiology including coronary angiograms and PCI.

Project Managers

Lindsey_Cooke_profile

 

 

Lindsey Cooke (previously Humphreys) has been a senior manager in both the College of Medical and Dental Sciences at the University of Birmingham and the NHS for many years. In the University she has managed both research and teaching activities and been responsible for one of the largest Institute budgets in the Medical School. She has led on the annual business planning process, budget management and forecasts, staff and project management. In the NHS she has managed most medical specialties including Cardiology and a Stroke Unit.

Emma_Lancashire_profile

 

 

Dr Emma Lancashire, Senior Research Fellow in the Institute of Applied Health Research at the University of Birmingham. Dr Lancashire joined the University in 1995 and has worked in both a research and project management capacity. She has been responsible for the management of a wide variety of research studies including several randomised controlled trials of complex interventions.

Helen_Shantsila_profile

 

 

Dr Helen (Alena) Shantsila, Research Fellow at the University of Birmingham. Dr Shantsila is a National Co-ordinator of the Atrial Fibrillation General Long Term (AF-GEN) Registry and AF-GEN UK extension study. She has managed the preparation of several EHRA consensus documents, which involved coordination of contributions from several international societies. Her main research focus is to understand mechanisms of blood pressure control and pathogenesis of hypertension, including malignant hypertension.

 

International Scientific Advisory Committee

 

Jeroen_Bax_profileProfessor Jeroen Bax, Professor of Cardiology at Leiden University and immediate past President of the European Society of Cardiology. His main research interests relate to imaging in clinical cardiology. In particular, the integration of different imaging techniques (nuclear cardiology, echocardiography, multi-slice computed tomography and magnetic resonance imaging) into clinical issues.

John_Camm_profileProfessor John Camm, Professor of Clinical Cardiology at St George’s University of London, consultant cardiologist at St George’s NHS Foundation Trust and past President of the European Heart Rhythm Association. He specialises in a number of cardiac issues which include: cardiac arrhythmias, sudden cardiac death, inherited channel pathyatrial fibrillation, ventricular tachycardia, cardiomyopathy and pacemakers. He also works with a focus on cardiac re-synchronisation therapy and ventricular repolarisation as well as other cardiac treatments.

Chern-Ern_Chiang_profileProfessor Chern-Ern Chiang, Professor of Medicine at the National Yang-Ming University and Director of the General Clinical Research Center (GCRC), Taipei Veterans General Hospital. He is also an attending Physician, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital. His medical expertise is in arrhythmia, hypertension, hyperlipidaemia and clinical trials.

Ken_Okumura_profileProfessor Ken Okumurais a Cardiologist from Japan and served as Professor of Medicine, Hirosaki University School of Medicine, Aomori, Japan, from 1996 to 2016. He is now working at Saiseikai Kumamoto Hospital Cardiovascular Centre, Kumamoto, Japan and is involved mainly in the management of patients with cardiac arrhythmias, catheter ablation of atrial fibrillation and clinical research. He also served as the President of the Japanese Heart Rhythm Society (JHRS) from 2011 to 2016 and was Congress Chairman of the Asia Pacific Heart Rhythm Society in 2017 (APHRS 2017) held in Yokohama, Japan. His main interest is the managements of cardiac arrhythmias, especially atrial fibrillation, including anticoagulation therapy, rate and rhythm control and catheter ablation with the latest technologies.

 Tatjana_Potpara_profile

Assistant Professor Dr Tatjana Potpara, Assistant Professor of Cardiology, Clinical Center of Serbia is a cardiologist with a 25-year clinical experience in a large academic hospital, and also runs a busy outpatient AF clinic. She is involved in teaching at the undergraduate and postgraduate level at Belgrade University School of Medicine, and serves as member of a PhD Collegium, University of Modena, Italy. Her main research areas involve cardiac arrhythmias, particularly AF. Dr Potpara is dedicated towards integrating the underrepresented countries in South-Eastern Europe into the ESC/EHRA research and other activities and strengthening the international collaboration. Her collaboration network involves most countries in Europe, as well as the US, Canada, Australia and Asia.

 Mellanie_True_Hills_profile

Mellanie True Hills is an atrial fibrillation patient (13 years afib-free), non-profit CEO, internationally-known author, Certified Speaking Professional (CSP), and passionate advocate for patients. She is the founder and Chief Executive Officer of the American Foundation for Women’s Health and StopAfib.org, a global atrial fibrillation patient advocacy organization. The organization’s mission is to help those living with atrial fibrillation to get their lives back and to rid the world of strokes caused by atrial fibrillation.

Successes include creating Atrial Fibrillation Awareness Month and lobbying with other organizations to gain U.S. Senate designation of September as National Atrial Fibrillation Awareness Month. Mellanie is the co-creator along with the American Heart Association of MyAFibExperience.org. She also served on the Patient-Centered Outcomes Research Institute’s PCORnet Patient Council.

 Caroline_Watkins_profile

Professor Dame Caroline Watkins, Professor of Stroke and Older People’s Care, Director of Research and Innovation; Director of Lancashire Clinical Trials Unit and Director of Lancashire research Institute For global hEalth and wellbeing (LIFE) is the only nursing professor of her kind in the UK.  She leads one of the largest multi-disciplinary teams of researchers with a large portfolio of clinically relevant research and contributes to stroke service development at local, national and international level for over 30 years.

She is passionate about stroke research and improvements in patient care.  She actively encourages staff at all levels of their research career and has been actively supportive of the development of Early Career Researchers. Her multidisciplinary team of researchers have a large portfolio of clinically relevant stroke research and contribute to stroke service development locally, nationally and internationally.

Contact

For those interested in collaboration or if you are a patient or member of the public who would like more information, please either:

Mrs Lindsey Cooke
Global AF Reach Programme Manager
The Murray Learning Centre
Institute of Applied Health Research
University of Birmingham
Birmingham
B15 2TT

Tel: +44 (0)121 414 3368

Dr Emma Lancashire
Global AF Reach Programme Manager
Public Health Building
Institute of Applied Health Research
University of Birmingham
Birmingham
B15 2TT

Tel: +44 (0)121 414 3999


Dr Helen Shantsila
Global AF Reach Programme Manager
IOEM Building
Institute of Applied Health Research
University of Birmingham
Birmingham
B15 2TT

Tel: +44 (0)121 414 3531

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