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