Cumbria is at heart of life-saving study

Based at Carlisle's Cumberland Infirmary, the Heart Centre provides life-saving treatment for those with urgent heart problems.

It sees patients from all over the county and south west Scotland, performing life-saving treatment to widen blocked arteries.

Run by North Cumbria University Hospitals NHS Trust, the centre is also part of a national study that could revolutionise heart treatment and help people live much longer, healthier lives.

It is not a trial of a drug, but a theory about how the body reacts during a heart attack. In essence, it is looking at whether they can give the heart a false kick start, so it stops dying and starts fighting back.

It uses a special cuff that needs to be fitted to the arm while a patient is undergoing urgent treatment at the unit.

These are patients who are having a heart attack there and then, and unless something is done quickly to unblock the artery, they will die.

After securing permission from the patient, the team attach the cuff - which applies pressure to the arm - during Primary Percutaneous Coronary Intervention (PPCI) treatment, to open the blood vessel.

The theory is that, the pressure will alert the brain to a problem elsewhere in the body, in this case the arm. The heart, which is dying, will then wake up and respond, reversing the decline.

This would mean that there would be less long term damage, and patients who survive would be less prone to heart failure.

Dr Madhusudhan Varma, intervention cardiologist, is heading the north Cumbrian arm of the ERIC-PPCI (Effect of Remote Ischaemic Conditioning on clinical outcomes in ST-segment elevation myocardial infarction patients undergoing PPCI) study.

He works alongside a team of researchers, from heart specialists to nurses, who are conducting the study.

"The study itself, from a consultant perspective, is moving forward our questioning," said Dr Varma. "We already know we are saving lives. The study aims to push that further.

"We are looking at whether, by doing this sort of study, we going to reduce deaths a year later.

"At the end of a two-year period we try to find out whether we've saved more lives than we would've done without it. We are essentially pushing the boundaries of patient safety."

Dr Varma heard about the national study and it immediately sparked his interest. He got in touch with those leading it, who came up to Carlisle from London to talk to the local team and see whether the Heart Centre was equipped to deliver the research.

The study launched in September 2015, with the first patient to sign up being from Cumbria.

Jeremy Hodierne, cardiac physiologist, said it is complicated, because they can't sign people up in advance.

"We are looking at patients who are having a heart attack there and then. We have to explain at that point what we are doing, and get permission to use the cuff," he explained.

Dr Varma said some patients are so ill and the atmosphere so charged that they don't ask them.

"The response is usually more positive than negative, but for some it is just too much. They are just too unwell. We have to make a judgement call on that," he said.

But in most cases they try, because they know the more patients they sign up, the more important the results, and the bigger potential of a breakthrough in heart treatment.

In order to ensure the research is accurate, some patients are fitted with a sham cuff, while others get the real thing.

Only those leading the study know which is which. Even Dr Varma doesn't know which of his patients have had the real device, and he said that ensures nothing can influence the results.

To date they have signed up more than 100 patients. "When we started we didn't think we would even hit 50, but we've more than doubled that and are still getting more," he added.

Chris Relph, research nurse, said that after initial consent is secured before treatment, they go back to the patient the next day to explain what is involved longer term, then formally enroll them.

Those who agree receive detailed follow up appointments and tests to analyse whether the cuff actually made a difference. "It's like a Rolls Royce service for people who get into the study," he said.

They then have to gather all of their information, including working with the ambulance service, GPs and A&E staff to establish exactly what treatment they had before arriving at hospital. This is to ensure there are no gaps in the study.

The team then has to keep in touch with the patient after they leave the unit, so they can monitor them longer term.

In some cases, patients have been visiting the area when they had their heart attack, and may be returning overseas.

For Dr Varma, the study is a natural progression from his previous PHD research, which looks at these cuffs and the optimal pressure that should be used to get results without causing discomfort.

And he strongly believes the theory behind the research.

He said there was a study 10 years ago, but not enough information was gathered so to date the cuff is not being used as standard practice. He hopes they can help change that.

Dr Varma explained the logic. "It is about seeing if the heart will pick up to help another part of the body, so that the cells that are dying do not give up because they have another job to do.

"We are telling the heart to 'man up', so to speak. That's the theory. we now just have to prove it," he said.

All major hospitals in the country are now involved in the study, but Carlisle has the fifth highest number of patients signed up to date.

Dr Varma said the key is having a passionate and motivated team, especially when they are working in an emergency environment where the first concern is to tackle the immediate heart attack.

Those involved hope it will boost the reputation of the hospital and make it more attractive to doctors and nuurses in the future

Anna McSkeane, research team leader, said they are also keen to be involved in more research projects in future.

"It raises our profile across the network and we are actually looking for other studies we can be involved in," she said.