Keeping hearts beating for 125 years

Throughout the University of Birmingham’s 125-year history and before, local academics have conducted medical research, including studying how the heart works. 

Electrical signals from the heart make it beat in a regular and coordinated way. But sometimes, this electrical system can go wrong and lead to major problems for patients. 

The University of Birmingham are world leaders in several areas of heart disease, including research into heart rhythm disorders such as atrial fibrillation, where the heart beats too slowly, too quickly or in an irregular way.

Atrial fibrillation already affects over 60 million people worldwide, and is expected to rise to over 100 million in the next few decades. It doubles the risk of early death, is the cause of 1 in 5 strokes and leads to poor quality of life for those affected.

Long history of innovation in heart and circulatory disease

William Withering was the first to trial and use digitalis to treat heart disease 240 years ago, in Birmingham. Now known as digoxin, it is still in use today to treat patients with heart failure and atrial fibrillation. Withering was a botanist and trained physician who worked at Birmingham General Hospital in the late 1700s. He became famous for recognising that an ingredient derived from foxglove could help heart patients. He studied this foxglove-derived ingredient and wrote about its effects and toxicity.  In 1948, the University of Birmingham School of Medicine established a Chair of Medicine post in his honour, named after him. 

Later, in 1960, Birmingham alumni, Leon Abrams and Ray Lightwood, developed and implanted the first patient-controlled variable pacemaker. Pacemakers are medical devices that can step in and send electrical impulses that control the rate and rhythm of the heartbeat when a person’s heart is unable to reliably do this alone. Birmingham has remained a leader in pacemaker technology, with the world’s smallest pacemaker being fitted in 2015 at the Queen Elizabeth Hospital, which is co-located alongside the University campus. 

Modern-day research to keep hearts beating steadily

In recent years, a team of researchers at the University of Birmingham, led by Professor Dipak Kotecha, have revived the use of digoxin in current clinical practice. First, they reviewed the safety and efficacy of digoxin in a BMJ paper, which looked at findings from studies all around the world. This then led to a clinical trial, co-designed with local heart patients, which considered quality of life of patients with atrial fibrillation and heart failure treated with digoxin compared to beta blockers. This year, they published economic analysis that demonstrates how use of digoxin could not only mean better care of older patients with atrial fibrillation and heart failure, but also has the potential to save the NHS £100 million each year.

Kotecha’s team conduct a wide range of research into atrial fibrillation, to improve the care that patients receive and to prevent adverse outcomes. In a recent Nature Medicine study, they used electronic health records from across the UK to show that the risk associated with atrial fibrillation is much broader than previously thought. Even younger patients with this condition had a two-fold higher risk of strokes and blood clots, and a 68% higher chance of developing vascular dementia.

To address this risk and try to prevent cognitive decline and vascular dementia in patients with atrial fibrillation, the team are leading a national project called DaRe2THINK. This collaborative effort is pushing boundaries in the way clinical trials are run. The trial makes use of primary care touchpoints in England and is already running across 400 NHS sites, using routine health information already collected to perform vital research that could lead to improvements in the health and wellbeing of patients. The trial opens the possibility reach of research to populations that would not have previously taken part.