10 out of 10 - ten of the greatest health-changing research studies, to have taken place in North Thames over ten years of the CRN

The NIHR Clinical Research Network was formed 10 years ago, in April 2014. To reflect on its mission to support clinical research, we are taking this opportunity to look back on the 10 years of its existence, and revisit some of the incredible research to emerge in the region that has had an impact on treatments and on the health and wellbeing of patients across the UK.

Which aspect of health did this research focus on? 

Cardiology / Stroke 

What was the study investigating?

This study sought to determine whether pacemaker patients who show signs of atrial fibrillation (AF) should be treated with the same blood thinning medication as patients without a pacemaker. 

Why does it matter?

If AF is picked up in patients without a pacemaker on an ECG or heart monitor, they would usually be given blood thinning medication if their risk of having a stroke is high, but those patients usually have symptoms, or have AF frequently enough for it to be picked up on a one-off ECG trace.  

Because pacemakers give clinicians the ability to detect heart rhythms continuously, they often pick up signals consistent with AF which may otherwise have passed without symptoms or cause for concern. It was not known therefore, if the same benefit of blood thinning anticoagulation applies. Unnecessary use of blood-thinning medication could expose patients with pacemakers to a risk of bleeding which might be greater than the risk of stroke prevention.

What did the study do?

The trial looked at over 2,000 patients, 65 years or older, with pacemakers, who experienced Device-detected atrial high-rate episodes (AHREs) lasting for at least 6 minutes, and who had at least one additional risk factor for stroke. 

Half the patients were given blood thinning medication and half were given a placebo, whilst researchers monitored the health for each set of patients.  

What did we learn?

The study found that there was no net benefit to anticoagulation in patients with pacemakers and that the risks of bleeding were quite significant.  

The results were announced at the European Society Congress, the world’s largest cardiology meeting and published in the New England Journal of Medicine. 

How has it benefited patient healthcare and treatments? 

The study addresses an issue which clinicians face in pacemaker clinics every day. The results could improve safety for patients who can now be protected from the danger of bleeding complications from blood thinning medication, as well as reducing their potential pill burden. There will also be a net cost benefit to the health system if less medication is now dispensed as a result.

What next?

Dr Afzal Sohaib, who lead the study at Barking, Havering and Redbridge University Hospitals NHS Trust, says:

“This was a large international study so with the study updates it was interesting to see how it progressed in other countries, as well as the UK. We also had to continue the study during covid which was a challenge. 

“But the results surprised many cardiologists. The risks of bleeding were quite significant. 

“This could represent a big shift in clinical practice, as it potentially means quite a large group of patients from pacemaker clinics might not need to be offered unnecessary anticoagulation, which in turn, could save lives.”