Health services research

Professor Martin Cowie, Head of Group

Welcome to the Health Services Research team, a research group within the Cardiovascular Sciences Division of the National Heart and Lung Institute. We are situated at the Royal Brompton and Harefield NHS Foundation Trust Campus in Chelsea, London. 

The aim of the health services research team is to advance knowledge on the epidemiology of cardiovascular disease and to facilitate the efficient and effective delivery of healthcare for these patients.

The Health Services Research Group led by Professor Martin Cowie was set up in October 2001 and researches the efficient and effective delivery of cardiovascular health care. This activity necessarily involves a number of disciplines: clinical (medical and professions allied to medicine), epidemiology, biostatistics, health economics and social science. Research is undertaken at European, national and community levels in studies principally focused on heart failure.

Our study and research cover a variety of areas:

• Remote monitoring
• Sleep disordered breathing
• Socio-economic status in heart failure
• Self care in heart failure

The group is also actively involved in the development of national guidelines for the management of heart failure, and interacts extensively with the local health care community in process redesign of the care of patients with cardiovascular disease.

Remote monitoring

HOME-HF

HOME-HF was a multi-centre randomized controlled trial of 182 patients involving three acute hospitals in urban, multi-ethnic North West London. Patients were randomised 1:1 to receive either usual care or telemonitoring. The primary outcome was days alive and days spent out of hospital. Secondary outcomes were number and duration of heart failure hospitalizations, clinic visits, and quality of life.  The study found no difference in the primary outcome between groups, but there were significantly fewer unplanned hospitalizations for heart failure decompensation, and a reduction in clinic and emergency room visits in the telemonitoring group. There was no statistically significant difference in the mean direct health service costs.

TeleCRAFT

The TeleCRAFT study aims are to:

1. Implement a telemonitoring programme in heart failure and COPD/chronic respiratory patients by assessing the real world impact of on readmissions, consults, home visits, quality of life and economic endpoints.
2. Explore the effects of telemonitoring across heart and respiratory groups with respect to i) factors that influence how patients integrate telemonitoring into their daily routines and self care behaviour and ii) how healthcare professionals use telemonitoring to aid decision- making.
3. Understand the impact of telemonitoring on a variety of care pathways.

The TeleCRAFT study is a Crossover implementation study with patients allocated randomly 1:1 to telemonitoring or delayed entry to telemonitoring (after 6 months). Comparisons will be carried out between patients with delayed entry (controls) and active telemonitoring. In the group receiving telemonitoring in first 6 month period we will be able to assess impact of withdrawal in subsequent 6 months.

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Sleep disordered breathing

SERVE–HF

A randomised controlled trial of patients with central sleep disordered breathing and heart failure which aims to see if the use of adaptive servoventilation (a newer form of ventilation) confers a survival benefit.

Socio-economic status in heart failure

SUSSEX–HF

A trial looking at the service usage and socioeconomic status examination in heart failure.

Self care in heart failure

GARFIELD-WESTON PROJECT

A study looking at the evidence base for an effective individualised self care management framework for heart failure patients following discharge from hospital.

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Selected publications

Dar O; Riley J; Chapman C; Dubrey SW; Morris S; Rosen SD; Roughton M; Cowie MR. (Mar 2009). A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home-HF study. EUR J HEART FAIL. 11:319-325.

Mehta PA; Dubrey SW; McIntyre HF; Walker DM; Hardman SM; Sutton GC; McDonagh TA; Cowie MR. (Nov 2009). Improving survival in the 6 months after diagnosis of heart failure in the past decade: population-based data from the UK. Heart. 95:1851-1856.

Cowie MR; Marshall D; Drummond M; Ferko N; Maschio M; Ekman M; de Roy L; Heidbuchel H; et al. (Jun 2009). Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population. Europace. 11:716-726.