Projects Delivered

We have recently shown that in patients with symptoms of angina, that a blood test called troponin can predict the severity of a type of heart disease called coronary artery disease. This is where the vessels in the heart have a build-up of fatty tissue that can lead to heart attacks and angina. We do not know if this blood test can be used in other settings to predict the severity of coronary artery disease.

In this study we will look at troponin levels in every patient who attends hospital for an angiogram dye test of their heart arteries, and see if this blood test can predict the severity of heart disease seen on the test. We will also look to see if troponin can predict risk of heart attacks and strokes.

In patients who come for an angiogram, we still don’t know if unblocking the build-up of coronary can help prevent future heart attacks and improve life expectancy. However, we think that a blood test like troponin could be able to tell us which patients at the highest chance of future heart attacks and strokes. This could allow us to avoid doing unnecessary procedures in patients who have a very low risk, and help prioritise tests and intensify medical treatments in patients who will benefit the most.

Project output: 

In August 2023, a journal article was published to share the results of this project: access the journal article 

In conclusion, researchers found that in patients with chronic angina, a blood test called troponin can objectively predict the risk of future heart attack or death independently from cardiovascular risk factors and disease severity. 

As explained in this medical press article, this conclusion suggests that routine troponin testing could help identify high risk patients who require further treatment.

A three-way collaboration between NHS Education for Scotland Digital Service (now called the NHS Education for Scotland Technology Service), NHS Lothian, and the Innovative Healthcare Delivery Programme, as part of a Scottish Government commission to develop a cancer treatment summary.

This is a data-scoping study supporting the NHS Education for Scotland Digital Service team to understand what data is available against the Innovative Healthcare Delivery Programme-defined minimum clinical dataset for cancer treatment summaries in head and neck cancer. The understanding from the project will inform the design and development of a cancer treatment summary to support clinical care and patient communication in this area in the future. This project with DataLoch will deliver an assessment of the data quality, data content and data source.

Project output:

This work was part of the first phase of a Scottish Government commission and informed the technical development of an electronic cancer treatment summary for patients. There is continued commitment to a national approach to cancer treatment summaries: see the cancer action plan 2023-2026 on the Scottish Government website.

White cells produce enzymes which help defeat invading disease-causing organisms. Some of these enzymes may also cause tissue damage and one in particular (elastase) may contribute to the invasion of coronavirus into lung tissue. No existing work has examined the relationship between circulating elastase and severity of coronavirus infection. Should a relationship be identified it opens up the possibility of using inhibitors of elastase as treatments for coronavirus infection. These inhibitors already exist as medical treatments, so they need only to repurposed not developed from scratch.

Patients with COVID-19 can be affected in many ways, many of which are only now coming to light as our knowledge of the virus develops. We know that patients with COVID-19 have an increased risk of cardiovascular complications such as blood clots and heart damage (myocardial injury). We also know that some patients with pre-existing cardiovascular disease, such as previous heart attacks or strokes, have a higher risk of adverse outcomes with COVID. Currently we are unable to tell which patients are at highest risk of these complications.

A European-wide initiative (COVIRNA) is aiming to develop a tool which will then better inform decision making and help clinicians discern who is at highest risk from complications of COVID-19.

In order to develop this tool they will gather pseudonymised data and blood samples of people with and without COVID from 10 centres across Europe, the University of Edinburgh will be one of the centres to provide this information using DataLoch data and samples from NHS Lothian.

Many people with COVID-19 recover quickly and return home, soon able to return to their normal level of function. However, some people become very unwell with COVID, and stay in hospital for a long time. It is important to understand how long people stay in hospital so that we can plan for the future. People may develop complications that need specialist help to return to normal function: rehabilitation. We will describe the rehabilitation needs of people admitted with COVID and the input provided by specialists (physiotherapy, occupational therapy, doctors who specialise in rehabilitation). We will see which aspects of a person’s previous circumstances or health affect their need for rehabilitation, such as their age, frailty or health conditions. We will describe how long people stay in hospital and how they are when they leave hospital, including whether they need more help once they return home.

Frailty and multimorbidity are terms used to describe people at risk of worsening health, increasing disability and death. These are often older people who have multiple health problems and frequently present to health and social care services at a point of crisis. However, identifying these vulnerable people earlier may allow extra support and assessment to prevent such crises. There are multiple ways of identifying frail or multimorbid people, but our current record systems for primary care (GP practices), secondary care (hospitals) and social care (carer support in the community) are not well connected. In this project, we aim to bring data together data from GP and hospital records to provide a combined view of patients’ health. Working with a cluster of GP practices in North East Edinburgh, we will provide reports of frailty and multimorbidity that may be used to test new approaches to the care of these patients.

The COVID-19 pandemic has challenged healthcare systems. As a new disease, the best evidence for patient management is still being collected. This is particularly true for older people with existing health problems, who often experience illness differently from younger individuals. Some older people are frail, a term that describes the loss of health reserves required to recover from illnesses such as COVID-19. Specialist geriatric medicine care improves outcomes for frail patients in hospital.

In consecutive hospitalised COVID-19 patients, we will see if the symptoms reported by frail patients, their families or carers differ from younger or non-frail patients. We will describe outcomes of frail patients, to report the risk of dying from COVID-19 and if this is greater than expected for their age and other health conditions. Finally, we will look at whether the pandemic has affected access to specialist geriatric medicine care for frail patients with and without COVID-19.

The COVID-19 pandemic is the biggest public health emergency of modern times. Initial reports suggested that short-term declines in kidney function (acute kidney injury [AKI]) were common in patients with COVID-19, and that pre-existing kidney problems (chronic kidney disease [CKD]) were associated with worse outcomes.

Here, we will use a large dataset containing a range of reliable and accurate data from all patients tested for COVID-19 in 3 large hospitals in Scotland (Royal Infirmary of Edinburgh, Western General Hospital [Edinburgh] and St. John’s Hospital [Livingston]) between March and December, 2020. This presents a unique opportunity to build on the initial, limited data regarding the risk and impact of AKI in COVID19, the implications of pre-existing CKD in COVID-19, and the risk of developing CKD in patients whose COVID-19 episode was complicated by AKI.

This project aims to increase our understanding of the relationship between COVID-19 and kidney disease, and will help plan future kidney healthcare resource allocation.

You can view the publication based on this project on the European Respiratory Journal website: https://erj.ersjournals.com/content/early/2022/04/29/13993003.03168-2021