Breakthrough research highlights Imperial’s strength in cardiovascular science

Three Imperial-led conference presentations have highlighted the university as a leader in cutting-edge cardiovascular disease research.

New research from scientists at Imperial College London could help to advance treatment and care for patients with heart conditions.

The work, funded by the British Heart Foundation (BHF), covers areas including the use of artificial intelligence to diagnose heart attacks, remote monitoring of high-risk patients, and highlighting increased heart disease risk for British South Asians.

The findings were presented this week (3-5 June) at the British Cardiovascular Society conference in Manchester, and gained widespread media attention.

AI tool rules out heart attacks in A&E patients

A new artificial intelligence (AI) tool, developed by Imperial PhD student Dario Sesia could rapidly rule out heart attacks in people attending A&E, allowing them to be safely sent home.

Blood tests are used to help confirm heart attack diagnosis for patients attending A&E. These measure levels of a protein called troponin, which rises when there is damage to the heart muscle. But this increase may not be a reliable sign until hours later, meaning people at low risk are often kept in hospital for further tests and evaluation before they can be discharged.

Our study shows how artificial intelligence can assist doctors in making more timely decisions about patient care, preventing unnecessary hospital stays, all while maintaining patient safety. Dr Amit Kaura National Heart and Lung Institute

The Imperial team developed, trained and fine-tuned the ‘Rapid-RO' AI tool using data from over 60,000 patients across the UK, before retrospectively testing it on over 35,000 patients across four UK hospitals.

Comparing the tool’s performance to existing methods of ruling out a heart attack based on troponin testing alone, they found that the tool successfully ruled out heart attacks in over a third (36%) of patients, compared to 27% ruled out by troponin testing alone.

The tool also missed fewer heart attacks (108 cases missed with blood tests versus 27 cases with the AI tool).

The researchers hope to develop the tool into an app that could be used by doctors to help support clinical decision-making to rule out heart attacks earlier and avoid unnecessary hospital stays, freeing up valuable NHS time and resource.

Dr Amit Kaura, Honorary Clinical Lecture in Imperial’s National Heart and Lung Institute (NHLI), who led the clinical evaluation, said: “Many patients require multiple troponin tests to confirm they're not having a heart attack, resulting in longer hospital stays and increased costs.

“Our study shows how artificial intelligence can assist doctors in making more timely decisions about patient care, preventing unnecessary hospital stays, all while maintaining patient safety."

[This research has yet to be published in a peer-reviewed journal]

Heart disease risk in British South Asian populations

Researchers from Imperial’s School of Public Health and NHLI have found that South Asians are almost twice more likely to have Coronary Heart Disease (CHD) than White Europeans.

The findings come from the largest study of its kind amongst UK South Asians, and finds South Asian men have at least double the risk of CHD compared to white European men. However, the incidence of CHD in South Asian women was similar to that of European men.

We hope that our work will make clinicians more aware of the increased cardiovascular risk of the South Asian community...It is crucial that everyone has the same chance of accessing the care they need when they need it the most. Dr Angad Kooner School of Public Health

The study, led by Professor Jaspal Singh Kooner from Imperial’s NHLI, is the longest and largest of its kind to assess CHD risk, and how sex differences within different ethnicities impact risk.

Analysing data from the LOLIPOP (London Life sciences Population) study, which uses health data from over 17,600 South Asians aged 35-75 for over 20 years.

The team found that even when risk factors such as higher rates of type 2 diabetes, high cholesterol and lower physical activity levels these were accounted for, South Asians still had a 1.7 fold higher risk of developing CHD.

Dr Angad Kooner, clinical research fellow at Imperial College London, who was also involved in the study, said: “We have made an incredibly important step towards understanding inequalities. We hope that our work will make clinicians more aware of the increased cardiovascular risk of the South Asian community.

“More research still needs to be done to better understand the factors driving this increased risk. It is crucial that everyone has the same chance of accessing the care they need when they need it the most.”

[This research has yet to be published in a peer-reviewed journal]

Remote monitoring to reduce risk

Finally, Imperial-led research showing that remote monitoring of heart attack patients significantly reduced readmissions to hospital is also being presented at the conference.

First published in the journal of the American College of Cardiology in April this year, the research involved a group of patients at Imperial College Healthcare NHS Trust at high risk of a second heart attack.

This simple strategy could potentially free up thousands of hospital beds and doctors’ hours across the country whilst keeping patients just as safe. Dr Ramzi Khamis National Heart and Lung Institute

In the study, half of the group from Hammersmith Hospital had specialist devices installed at home, allowing them to send vital signs and call cardiology teams for a remote consultation (‘telemedicine’) if they experienced any worrying symptoms.

The other half of the group followed normal care pathways, taking medicine and either consulting their GPs or attending hospital if they were concerned.

The remotely monitored patients were 76% less likely to be readmitted to hospital within six months and 41% less likely to attend A&E, compared to the other group. Even for those who were readmitted to hospital, the average length of stay was half a day – much less than the average one and a half days in the standard care group.

Dr Ramzi Khamis, Consultant Cardiologist and BHF Research Fellow at Imperial’s NHLI, who led the study, said: “This simple strategy could potentially free up thousands of hospital beds and doctors’ hours across the country whilst keeping patients just as safe.”

Effect of the microbiome

Also at the conference, Professor Marc-Emmanuel Dumas of the Department of Metabolism, Digestion and Reproduction delivered a talk on his group’s research into the effect of the gut microbiome on cardiometabolic diseases, such as diabetes, hypertension and ischemic heart disease.

He discussed how they are using machine learning to identify individual metabolites and their microbial genes involved in the progression of cardiometabolic diseases and to discover how they act. This work is paving the way for new understanding of the mechanisms impacted by the gut microbiome and new therapeutic avenues targeting the microbiome.

This article is based on materials from the British Heart Foundation. For more information visit the BHF news website.