Written by James Coker | Reporter, European Medical Journal | @EMJJamesCoker
As part of National Heart Month in the UK, which takes place every February, EMJ sat down with the world-renowned British Heart Foundation (BHF) to discuss a number of cardiovascular care topics. In this fascinating interview, the BHF told us all about their campaign initiative called “Thank You”, commemorating the most important research contributions the charity has made to the field over the last 50 years, and how these have changed the way we have looked at heart disease ever since. We went on to discuss the positive effect the BHF has had on government healthcare policy over the years, their current research projects, and potential future research avenues the charity is focussing on, as well as information about some of the direct services the BHF provide to people affected by cardiovascular diseases.
Q: Could you tell us about the BHF’s latest “Thank You” campaign? What are the main aims and scope of this initiative?
A: People often associate the BHF with saving lives, but don’t always realise that the way we’re tackling heart and circulatory disease is through research. From pacemakers to heart transplants, our “Thank You” campaign will celebrate some of the medical breakthroughs led by BHF researchers over the past 50 years, and how their findings have helped to keep millions of hearts beating. If the past is anything to go by, with the commitment of our supporters, we will continue to take huge strides in improving our ability to treat cardiovascular disease.
Q: What are the most prominent research achievements the BHF has had during the last 50 years that will be focussed on during the campaign? Please could you describe how these have changed the face of cardiology care and continue to do so to this day?
A: The BHF was founded in 1961 by a group of doctors who were concerned about the growing epidemic of heart disease. At this time, heart attack patients were admitted to general wards and treatment was simply painkillers and bed rest. The BHF helped to establish the UK’s first coronary care units, which revolutionised how heart attack patients were cared for and dramatically lowered the death rate through painstaking research.
In 1976, BHF Professor Michael Davies published a ground-breaking paper proving that heart attacks are caused by blood clots. It’s amazing to think that we had landed a man on the moon before we knew the cause of heart attacks. In 1965, we funded the use of the first defibrillator in an ambulance. We went on to fund thousands of defibrillators for use in emergency vehicles, transforming the way cardiac arrests were managed in emergency care. Today, all ambulances carry a defibrillator and are ready to treat the 30,000 out-of-hospital cardiac arrests that occur every year.
BHF researchers have also been deeply involved in the development of heart surgery and 1967 saw the first successful surgical technique developed for replacing damaged heart valves. The techniques are still used today and have increased life expectancy of patients by up to 20 years. Our dedicated researchers have also identified some of the genetic mutations behind a number of deadly inherited heart conditions. If left undetected and untreated, an inherited heart condition can sadly lead to heart failure or even sudden death from cardiac arrest. For many families, the first sign that there is a problem is when someone dies suddenly with no obvious cause or explanation. Identifying the mutation that causes an inherited condition is crucial. It means families can be screened, reassured if they do not have the mutation, or treated and monitored if they do.
Familial hypercholesterolaemia affects 1 in 250 individuals in the UK and causes extremely high cholesterol levels from childhood, leading to sudden heart attacks in people aged <50 years. BHF researchers identified the genes responsible and have helped to implement genetic testing across the NHS. Early detection of familial hypercholesterolaemia is key because people carrying the abnormal gene can be treated with drugs like statins to lower their risk of heart disease.
Q: How much have the aims and scope of the BHF changed, or broadened, since it was founded in 1961?
A: Advances in cardiovascular research mean that the scope of our work is constantly changing to tackle the challenges relevant at the time. With every new discovery there is a new challenge. Initially focussing on heart disease, this has broadened over the years and we currently fund research across the whole spectrum of heart and circulatory diseases like stroke and vascular dementia, as well as their risk factors including diabetes and hypertension.
The way we tackle these problems has also changed, with the advent of genomics and big data providing powerful new tools for understanding and beating these conditions.
Q: How much of an impact has the BHF had on UK government policy over the years?
A: The BHF has been highly influential in shaping the infrastructure that enables scientists to conduct ground-breaking medical research and develop new technologies in the first place. Without funding agreements, regulatory frameworks, and a life sciences sector that fosters collaboration across borders, researchers would struggle to do their work. By working with policymakers in government and beyond, we help to ensure the UK remains an attractive and welcoming place for science and innovation in general, and for research into heart and circulatory disease in particular.
In the past, the BHF called for government to introduce measures to reduce the cardiovascular impacts of smoking and the BHF’s role in the successful campaign to introduce standardised cigarette packaging is well known. Today, the BHF continues to work with policymakers to introduce measures to help prevent the causes of heart and circulatory disease. While many people associate pollution solely with respiratory illness, it’s a major issue for heart and circulatory disease as well. Alarmingly, 80% of air pollution-related deaths worldwide are caused by cardiovascular disease. Tackling the UK’s air pollution problem is a priority for the BHF, and we work closely with Public Health England (PHE), the Department for Environment, Food and Rural Affairs (DEFRA), and regional authorities to secure real policy changes.
Our vision is for a world in which no one dies prematurely from heart and circulatory disease. With this vision, we support the government’s proposal to introduce a system of presumed consent for organ donation, and we have worked with the Department of Health and parliamentarians in all four nations of the UK on this subject. We are also part of a coalition with other health charities that campaigns for cardiopulmonary resuscitation (CPR) to be taught in all schools across the UK.
Q: The BHF funds, and is involved in, a lot of research activity. Could you provide a few examples of the research that has had the greatest impact on patients’ lives?
A: Some of our greatest successes are the improvements in survival rate after a heart attack. Before we were founded, only 3 in 10 people survived a heart attack. Our researchers have carried out clinical trials in large cohorts, which generated compelling evidence for the benefits of aspirin, beta-blockers, and statins in patients with coronary artery disease and also the benefits of angiotensin-converting enzyme (ACE) inhibitors in patients who are suffering from heart failure. These drugs are now standard treatment in patients who have had a heart attack, not only in the UK but worldwide. This research contributed to advances in heart attack care and, thanks to worldwide research efforts, today 7 in 10 people in the UK survive after a heart attack.
We have also been proud to support the research of Professor Sir Magdi Yacoub at Harefield Hospital, UK, who developed pioneering cardiac surgical techniques, including improvements to transplantation. His work has transformed the lives of many people, especially young children born with heart problems.
Q: What areas of research are the BHF currently focussed on, and what are the outcomes you are hoping to get from these?
A: An exciting area we have been funding is regenerative medicine. Only a few years ago, it was generally accepted that heart muscle cells in adults did not divide, and that the damaged heart was irreparable. We now know this is wrong and we are working to harness the potential of stem cells in repairing the heart by encouraging the tissue to regrow and regenerate. Regenerative medicine has implications across all areas of cardiovascular medicine, particularly for treating heart failure.
Heart failure is currently incurable and carries a prognosis worse than many cancers. Some of our researchers have shown that heart cells of adult mice can be stimulated with chemicals to repair the heart damage. They have identified a molecule called thymosin β4 (tβ4) that helps specialist cells in the surrounding heart tissue to move into the damaged area and develop into new heart muscle. The group is now screening thousands of small molecules to see if they can also assist heart regeneration. Additionally, researchers are working on growing patches of living heart tissue in the lab, which could be used to ‘patch’ damaged hearts and restore their pumping ability.
Q: What is the single issue that requires the most urgent attention with regard to heart disease in the view of the BHF?
A: There are so many aspects of cardiovascular disease that need urgent attention. A recent challenge is that many people have come to perceive heart and circulatory disease as preventable and lifestyle-driven. However, we know that these conditions can affect anyone, at any stage of life. For those diagnosed with heart and circulatory disease, a major issue is simply making sure they are aware of and their care complies with existing treatment guidelines.
However, there are many cardiovascular diseases for which our understanding of the disease processes, and therefore development of effective treatments, is underdeveloped. Understanding the basic science is crucial to developing treatments that actually work in clinical practice. For example, atrial fibrillation (AF) is a disturbance in the heart rhythm that occurs particularly in older patients and not only impedes heart function, but is a major risk factor for stroke. At the moment, we reduce the risk of stroke by prescribing patients with blood thinners, which increases the risk of bleeding. Another treatment is ablation, which uses heat or freezing to produce scar tissue in problematic areas of the heart. The treatment aims to destroy the patch of cells where the abnormal heart rhythm is being initiated, or break the abnormal circuit in the heart tissue; however, these treatments do not tackle the cause of AF. Our researchers are currently working on understanding the mechanisms that lead to disrupted heart rhythms and how to restore normal heart function in a more refined way.
Q: With regard to your helpline, what are the most common queries that you hear from patients and their relatives? How vital is this aspect of the work of the BHF?
A: Our Heart Helpline has cardiac nurses available to answer questions from the public. It aims to give people the information and support they need so they can make informed decisions about their care alongside their doctor. We generally hear from people who are suspected to have, or have been diagnosed with, a heart condition. The most common queries usually involve medications, investigations, and treatment options. Our website contains a lot of information, but the helpline is a more personalised approach where patients can receive instant support.
Q: Has an ageing population contributed to the high prevalence of heart disease in the UK? Has the BHF undertaken strategies particularly targeted to this population group?
A: Despite our advances, there are a growing number of people living with heart and circulatory diseases, both as more people survive heart attacks and strokes, and as life expectancy rises. For example, statistics show that hospital admissions for heart failure have increased by 36% in a decade in the UK, while survival rates have not improved. Tackling heart failure is a significant challenge, both in terms of funding research to improve treatments and supporting the health service to find affordable ways of improving care for the growing number of people living with it.
To access the website of the British Heart Foundation, click here.