Professor David Fitzmaurice

• MBChB 1987 (Birm)
• MRCGP 1995
• MD 2000
• FRCGP 2002

David Fitzmaurice qualified from the University of Birmingham Medical School in 1987. He was appointed as the first academic trainee GP in 1993, He has contributed to the growth of the department, particularly within the research arena, culminating in the Department receiving a 5* rating at the last Research Assessment Exercise. He continues to undertake 2 sessions of clinical practice per week in an inner city general practice.

He has been involved in several large scale studies and has published around 100 papers in peer-reviewed publications. His main research interest has been in the area of anticoagulation research, particularly focussing on the primary care management of oral anticoagulation and venous thromboembolic disease. This work has led to the “Birmingham Model” of oral anticoagulation management, comprising a practice nurse led clinic utilising near patient testing for INR measurement and computerised decision support software to assist with dosing, being recognised both nationally and internationally as a credible alternative to the traditional hospital out-patient model of oral anticoagulation management. This, in turn has led to the development of the concept of patient self-management of oral anticoagulation with the SMART trial, an MRC funded trial of self-management versus routine care, demonstrating the clinical effectiveness of this model within the UK. He was PI on the landmark BAFTA study which demonstrated the superiority of warfarin over aspirin as stroke prevention for patients aged 75 and over with atrial fibrillation. The relative success of this programme of work was recognised with an NHS Career Scientist Award in 1999.He has been invited to speak at numerous national and international scientific meetings of primary care, cardiology and haematology, for example, the Society for Academic Primary Care, the North American Primary Care Research Group, The British Cardiac Society, the British Society for Haematology, The International Society for Haemostasis and Thrombosis. He represents Primary Care on various national and international bodies with an interest in these areas, very often being the only primary care input into specialist organisations, for example, the British Committee for Standards in Thrombosis and Haemostasis (BCSTH), the International Society for Anticoagulation At home Monitoring (ISAAM), The Royal College of General Practitioners Research Group.

More recent work has included investigations into the genetic basis of warfarin sensitivity, performance evaluations of diagnostic tests and registry based studies around atrial fibrillation and patient self-management of oral anticoagulation. He currently reviews for around 30 peer-reviewed journals, including the Lancet, British Medical Journal, JAMA, BJGP, and the British Journal of Haematology.

In parallel with the development of this programme of research David has developed a wide-ranging suite of post-graduate education, comprising both Masters level and non-accredited activity. This is focussed within the National Centre for Anticoagulation Training which is based within Primary Care Clinical Sciences

RESEARCH THEMES

Cardiovascular disease, Thrombosis and Haemostasis, Atrial Fibrillation, Venous Thrombo-Embolism, Respiratory disease

RESEARCH ACTIVITY

Cardiovascular Disease

The broad theme of David’s research has primarily been around cardiovascular disease encompassing screening and treatment of common cardiovascular disorders, developing models of care incorporating new technologies and prevention and treatment of venous thrombo-embolic disease. This has been undertaken through a growing research team within the University of Birmingham and also in collaboration with both primary care and specialist colleagues in the UK and overseas.

He was a visiting lecture to McMaster University in 1999 and was awarded the Hooker Research Prize whilst there. Subsequently David was awarded one of the first Department of Health/MRC Senior Scientist Awards, a prestigious 5 year award entitled “The integration of new technologies to facilitate oral anticoagulation management”.

He is currently PI on an 5 year NIHR programme grant “Improving the prevention and treatment of VTE in the hospital and community”.

Thrombosis and Haemostasis

David has pioneered the shift of anticoagulation management from secondary to primary care. This has been a gradual development from a 2 centre pilot study using computerised decision support for oral anticoagulation dosing, through and MRC funded multi-centre study which incorporated point of care testing, and finally an MRC funded study or patient self-management (the SMART study). These studies have established the evidence base for both primary care oral anticoagulation management and self-management and have led to the Nationally Enhance Service for oral anticoagulation and the development of UK national guidelines for self-management. David’s oral anticoagulation clinic received beacon status in 1998.

On-going evaluations of models of service delivery, including technology assessments of point of care devises and computerised decision support software has established the University of Birmingham as the leading centre for primary care research in this area. This has also led to the commercial development of a specific software package, BAP-PC which is commercially available.

Atrial Fibrillation

A natural development from the work around anticoagulation was into the area of atrial fibrillation, the commonest indication for warfarin therapy world-wide. A screening study commissioned by the Department for Health (the SAFE study) demonstrated that opportunistic screening was the most cost-effective method for identifying atrial fibrillation in patients aged 65 and over within primary care. This study has been widely cited and has been incorporated into NICE guidance and national policy.

An MRC funded RCT (the BAFTA study) demonstrated the superiority and safety of warfarin as compared to aspirin for stroke prevention in patients aged 75 and over. Again this has been widely cited and has been incorporated into national and international guidelines (eg ESC AF guidelines 2010)

Venous Thrombo-Embolism (VTE)

VTE kills more people per year than deaths from road traffic accidents, breast cancer, MRSA and HIV/AIDS combined. At least 32,000 deaths per year are attributable to hospital admission. David’s current NIHR programme grant has 3 work-streams, one of which is investigating the barriers to thromboprophylaxis amongst primary and secondary care clinical staff as well as health care commissioners. Further workstreams include an RCT of extended treatment for established VTE and a cost-effectiveness modelling exercise to determine the optimum treatment pathways for patients who are suspected of having a VTE.

Respiratory Disease

Early work investigating the utility of different types of inhaler device for patients with asthma has developed into a successful NIHR programme grant investigating the natural history of Chronic Obstructive Pulmonary Disease (COPD). This is being undertaken in collaboration with colleagues in Public Health and Occupational Health as well as specialist colleagues in respiratory medicine form UHB.

• Member of MRC Advisory Board (MAB), since 2003
• Director, National Centre for Anticoagulation Training (NCAT), since 2006.
• Member of Chief Medical Officer’s Expert Working Group on Thromboprophylaxis. 2005-2007.
• Member of European Society of Cardiology Scientific Sub-Committee on Venous Thromboembolism, since 2008.
• Member of International Society of Thrombosis and Haemostasis Scientific Sub-Committee on Computer Assisted Anticoagulation Dosage, since 2008.
• Advisor to NHS Improvement “Commissioning for Stroke Prevention in Primary Care”. 2008
• Advisor to GRASP-AF Toolkit. 2008. www.improvement.nhs.uk
• External advisor to Oxford Centre for Monitoring and Diagnosis (MaDOx) since 2008.
• External Advisor to HTA. 2008
• Member of International Research Quality Review Panel. University of Cork. 2009.
• Reviewer for NHS Clinical Knowledge Summary: “Stroke and TIA”. 2009.
• Co-chair UK Thromboprophylaxis Forum, since 2009.
• Editorial Board member, Thrombus, since 1996.
• Editorial Board member, British Journal of Cardiology, since 2003.
• Editorial board member, Biomed Central: BMC Cardiovascular Disorders, BMC Family Practice and BMC Health Services Research.
• Editorial Board Member, Primary Care Cardiovascular Journal. Since 2008
• Editorial adviser to British Medical Journal, since 2000.
• UK representative to International Society for Monitoring of Anticoagulation At home (ISMAA), since 2000.
• Board member, Society of Academic Primary Care, since 2001.
• Board member, Primary Care Cardiovascular Society, since 2001.
• Chairman, British Primary Care Anticoagulation Society, since 2002.
• Clinical advisor to Anticoagulation Europe, since 2002.
• Primary Care representative to Anticoagulation Specialist’s Association, since 2002
• Board member, Royal College of General Practitioner’s Research Committee 2002 - 2006.