Epidemiology and primary care
Primary care is the frontline, general practice healthcare delivered to people in the community. Epidemiology, the study of distribution and patterns of health in the population, underpins public health research, and thus overlaps with primary care studies.
With cardiovascular disease being extremely common and widespread in the general population - the global number one cause of death according to the World Health Organisation (Sept 2011) - clearly epidemiological and primary care research is absolutely critical in the mission to reduce heart-related death rates. Research in this area has a big influence on general practice.
The goal of primary care research within Bristol CardioVascular is to improve the identification, diagnosis and treatment decisions at the front end of the care pathway for patients either at high risk of developing, or already displaying manifest coronary artery disease.
Epidemiological approaches are being used to probe into further important aspects of cardiovascular disease: the causes (aetiology), prevention, treatment and the patient experience. Methodologies include:
- Lifecourse epidemiology
investigating how factors at different stages of life may contribute to risk of disease, based on data from a wide range of cohort studies
- Randomised controlled trials
now formally under the umbrella of the Bristol Randomised Trials Collaboration (BRTC)
- Genetic and molecular epidemiology
examining how genotypes relate to life events, environmental factors and the development of disease
- Assessment of population needs and healthcare outcomes
Looking at inequalities in access to and use of health services, the perception and assessment of needs, how healthcare is evaluated, and examining how future healthcare needs can be met
Research is conducted in the School of Social and Community Medicine (based at Canynge Hall and Oakfield House), within which is the Centre for Academic Primary Care and Bristol Randomised Trials Collaboration (BRTC).
Collaborators include the following departments:the Nuffield department of Primary Care Health Sciences at the University of Oxford, Primary Care Clinical Sciences at the University of Birmingham; and the Research department of Epidemiology and Public Health at UCL; also the local NHS Trusts - UHBristol Foundation Trust and North Bristol NHS Trust.
Characteristic methods and techniques routinely used in this area of research include:
- Cohort studies (ranging from initial recruitment and questionnaires to databases and ongoing maintenance)
- Randomised controlled trials (RCTs)
- Biobanking (plasma, serum, urine etc; also lymphoblastoid cell lines, DNA extraction)
- Statistical techniques
- Genetic techniques: SNP typing, sequencing, CNV typing, transcriptomics, methylation analyses
Current projects and highlights of research include:
- The Avon Longitudinal Study of Parents and Children (ALSPAC) 'Children of the '90s'
This longterm project represents an amazing resource for healthcare research. A cohort of more than 14,000 mothers enrolled during pregnancy in 1991-92, and the health and development of their children has been followed in great detail ever since, providing a vast amount of genetic and environmental information to understand how the physical and social environment interact, over time, with genetic inheritance to affect the child's health, behaviour and development. See the ALSPAC website.
- BARACK D
Randomised controlled trial testing the efficacy of spironolactone - a type of diuretic - in reducing heart attacks and strokes in the early stages of Chronic Kidney Disease (Feder).
- Clinical Cohorts in Cardiac Care (4C)
A cohort study of consecutive patients with new onset stable chest pain recruited in chest pain clinics and catheter labs (Feder, Juttner)
- Chest pain cohort in primary care
Pilot of cohort of new onset chest pain patients presenting in general practice (Montgomery, Feder, Coghill)
- Classifying genes associated with cardiovascular disease
Certain genes are thought to act as risk factors for developing cardiovascular disease, a 'complex trait' likely to emerge from the interaction of multiple genetic and environmental components. Research is being carried out to use a systems approach to genotype 50,000 single nucleotide polymorphisms in cardiovascular disease candidate genes. (Gaunt)
An ethnographic study of patients with cardiac failure at high risk of hospital admission (Purdy, Rosemary, Cramer)
- Optimising Management of Angina (OMA)
A pilot trial of a decision support system in rapid access chest pain clinics. (Feder, Johnson, Cramer, Evans)
Please also see current projects in Social and Community Medicine.
Further details on population and primary care epidemiological research can be found at: