A 40 minute test for angina could help patients avoid an overnight stay in hospital, according to research funded by the NIHR Guy's and St Thomas' Biomedical Research Centre.
The MR-INFORM trial looked at whether magnetic resonance imaging (MRI) could be used to guide treatment decisions for angina patients, rather than performing a more invasive procedure.
Angina is chest pain caused by reduced blood flow to the heart muscles. The condition affects two million people in the UK and is a warning sign that you could be at risk of a heart attack or stroke. Treatments include drugs to lessen the pain and changes to a healthier lifestyle.
Currently patients diagnosed with the condition are usually sent for an invasive angiography, a procedure which involves taking X-rays of the patient's arteries, and involves multiple hospital visits, including an overnight stay. If the condition is severe, patients have a procedure to improve blood flow to the heart called revascularisation.
The MR-INFORM trial looked at 918 patients with angina and risk factors for coronary heart disease, who were divided into two groups. One received the standard invasive angiography. The other had the 40 minute MRI perfusion scan of the heart, to decide whether to send the patient on for invasive angiography.
The two groups had similar outcomes for patients' health with under 4% of patients in both groups having cardiac events (such as heart attacks), in the following year. However, the group whose treatment was dictated by their MRI scan had significantly fewer procedures, with only 40% of this group going on to have invasive angiography. Only 36% of the MRI group went on to have revascularisation, compared to 45% in the other group.
Professor Eike Nagel, a consultant cardiologist and chair in Clinical Cardiovascular Imaging at King's College London, led the research. He said: "Personalising patients' treatment for angina will mean that we can target the more invasive treatments only to those patients that really need them.
"We have shown that MRI imaging, which is less invasive than current diagnostic tests, could mean that patients' initial visits to hospital are quicker and more patient friendly, and that they are less likely to have further procedures. But crucially the outcomes for patients of taking this approach were similar, so there is no negative impact of directing treatment in this way only to those we're sure need it.
"We are really grateful to patients across Europe who participated in the study."
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The research was funded by the NIHR Guy's and St Thomas' Biomedical Research Centre, and the German Center for Cardiovascular Research (DZHK), with supplemental corporate support from Bayer (Leverkusen, Germany) as an unrestricted grant payable to King's College London.
Contact: Anna Perman, Communications Manager, NIHR Biomedical Research Centre at Guy's and St Thomas' and King's College London tel: 07717 817 714 or e-mail: anna.perman@gstt.nhs.uk
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About the NIHR Biomedical Research Centre at Guy's and St Thomas'
The National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at Guy's and St Thomas' NHS Foundation Trust and King's College London works to develop and deliver new medicines and diagnostics to patients, drive research and innovation into the NHS, and provide national systems leadership for maximum impact to patients. With our research activity organised into nine themes, each holding an individual Athena Swan Silver award highlighting our commitment to equality and diversity, and supported by our interdisciplinary, world leading infrastructure, we are poised to deliver the next step change for the health and wealth of our nation. http://www.guysandstthomasbrc.nihr.ac.uk/ About the NIHR The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
- Funds, supports and delivers high quality research that benefits the NHS, public health and social care
- Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. http://www.nihr.ac.uk/patientdata
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New England Journal of Medicine