Currently, patients with heart (coronary artery) disease suffer because the quality of care they receive varies between hospitals, health professionals, and between different socio-demographic groups.

The study proposes – a world first – to link detailed primary care records with detailed hospital care records, and to carry out a major new clinical trial (the OMA trial) in rapid access chest pain clinics, the interface between primary (general practice) and secondary (hospital) care for patients with new onset stable heart disease.

Professor Gene Feder of the University of Bristol, a principal investigator on the programme, believes that the current variation in patient care is unacceptable. But it is difficult to know what to do about it, given that surprisingly little is known about how patient outcome (defined as a heart attack, unstable angina or death) is affected by the care given at various steps in the process of treatment.

Part of the programme will track the patients’ contacts with doctors and nurses in general practices and in all 230 hospitals nationwide, using established patient records.  This study aims to identify the extent and consequences, in terms of heart attacks and early death, resulting from missed opportunities for preventative care during the ‘patient journey’ from general practice to chest pain clinics to in-patient hospital wards.

It will aim to answer the following questions:

1. What are the most important opportunities for improving outcomes for patients in general practice and hospitals?

2. How does the care given in individual hospitals vary, and how does this influence patient outcome?

3. Can we cost-effectively improve the service near the beginning of the journey, in hospital chest pain clinics?

4. Should new blood tests routinely be used in the NHS to better target which patients undergo heart operations, such as bypass grafts?

Another part of the programme, the Optimising Angina Management (OMA) trial will recruit patients from 50 hospital chest pain clinics to test a multi-faceted programme of education and support which aims to improve clinical decision making.  The patients will then be followed up over three years for any cardiovascular events, such as heart attack.

The patients recruited into the trial will also help investigate the usefulness of eight biomarkers, recommended by European guidelines for risk assessment in angina, that have not yet been rigorously evaluated.

The pilot study for the trial will take place at the Bristol Royal Infirmary (BRI) with the support of the University Hospitals Bristol NHS Foundation Trust and championed by Jenny Tagney, cardiology nurse consultant and clinical lead of the BRI rapid access chest pain clinic.

Professor Feder said: “Expected benefits are fewer heart attacks, fewer hospital admissions, and longer survival for patients with heart disease.  We hope that our findings will then be used as a guide for heart disease treatment by NHS policymakers, doctors, nurses and patients."

BMJ Group Award

Professor Feder, Professor Harry Hemingway of University College London and Professor Adam Timmis of the University of York, have collectively been shortlisted for a BMJ Group Award in the Outstanding Achievement in Evidence Based Health Care category for their work to promote effective cardiac health care through relevant research. Their various angina research projects have drawn attention to deficiencies in the care of this common condition. The ongoing research has a clear mission which is to improve clinical outcomes for patients with angina.