PhD: Developing a prediction model for LVSD / Heart Failure
Heart failure is a clinical syndrome of fatigue, oedema and breathlessness in the presence of cardiac dysfunction. Many patients with heart failure are undiagnosed. Some of these patients have heart failure with reduced Left Ventricular Systolic Dysfunction (LVSD). Others have heart failure with preserved ejection fraction. LVSD is the commonest cause of heart failure. Symptomatic LVSD has a poor prognosis and high healthcare utilisation costs but appropriate treatment improves outcomes.
Early treatment of heart failure with LVSD or even LVSD before it has progressed to heart failure is beneficial. There is therefore a case for identifying patients with LVSD and with symptomatic heart failure. Many UK patients with heart failure remain undiagnosed.
Difficulties in identifying heart failure are well recognised and in the UK are complicated by restricted access to echocardiography facilities.
One strategy to improve identification of patients with LVSD and with symptomatic heart failure is to undertake selective screening or case finding.
The aim of this study is to derive a prediction model for heart failure using analysis of data routinely recorded in primary care. This prediction model would be incorporated into existing electronic patient records software to identify patients whose characteristics indicate they are have a high probability of having LVSD or symptomatic heart failure and to assist in the earlier diagnosis of heart failure.
A retrospective cohort study of adults aged ≥30 years in a large anonymised database of electronic primary care records.
This doctoral thesis will develop and make use of skills in epidemiology and statistical analysis and in the handling of large datasets of electronic primary care records.
Applicants should hold or realistically expect to obtain at least an Upper Second Class Honours Degree in a relevant health or social science subject and have skills in data analysis.
Alternatively applicants may hold or realistically expect to obtain at least an Upper Second Class Honours Degree in a relevant subject that includes substantial analytic skills such as statistics, mathematics or computing science, but have a demonstrable interest in health and health care.
Self-funded students only
National Collaborating Centre for Chronic Conditions on behalf of the National Institute for Clinical Excellence. Chronic heart failure: management of chronic heart failure in adults in primary and secondary care. Salisbury. Royal College of Physicians 2003. http://www.rcplondon.ac.uk/pubs/books/chf/heartfailure.pdf [Last accessed 20th February 2006]
Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigators. New England Journal of Medicine 1992;327:685-91.
Pfeffer MA, Braunwald E, Moye´ LA, Basta L, Brown EJ Jr, Cuddy TE, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. New England Journal of Medicine 1992;327:669-77.
Redfield MM, Jacobsen SJ, Burnett JC, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: Appreciating the scope of the heart failure epidemic Journal of the American Medical Association 2003; 289: 194-202.
Davies M, Hobbs F, Davis R, Kenkre J, Roalfe AK, Hare R, Wosornu D, Lancashire RJ. Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study Lancet 2001; 358(9280):439-44.
Fuat A, Pali S, Hungin S, Murphy JJ. Barriers to accurate diagnosis and effective management of heart failure in primary care: qualitative study. BMJ 2003; 326:196-202.
Khunti K., Hernshaw H., Baler R., Grimshaw G. Heart failure in primary care: qualitative study of current management and perceived obstacles to evidence-based diagnosis and management by general practitioners. The European Journal of Heart Failure 2002; 4:771-777.