Projects Delivered

More than one third of patients seeking urgent hospital treatment in Scotland do so because of breathing
difficulties. Research tends to focus on diseases (e.g. asthma) rather than symptoms like breathlessness.
The patient journey across different parts of the health service has not been well studied.

In this project, we will study patients that attended the Royal Infirmary of Edinburgh’s Emergency Department
with breathlessness and investigate what happened next. We will look to better understand the patterns of
referrals, tests, appointments, and other outcomes that follow a hospital attendance. We will try to
understand the effect of the COVID-19 pandemic on this group of patients. Our analysis will use techniques
that help predict how likely it is that a patient will follow a particular treatment pathway. The purpose of this
work is to guide improvements in these pathways in the future, for example by reducing unnecessary delays
to treatment or testing.

Heart disease is common and a heart attack is the leading cause of death or disability in older patients. In our research so far, we have shown that older patients receive fewer recommended treatments for a heart attack compared to younger patients, despite being at higher risk of future heart problems and therefore potentially having the most to gain from therapy. Multiple health problems and the risks of complications make it more difficult for clinicians to choose the best treatment for many older patients.

We want to learn the reasons behind treatment differences between younger and older patients and use this information to develop tools, personalised for each patient, which can aid decision making in this increasingly common patient group. This will help patients and their families make informed decisions about their care and doctors to identify patients who will benefit from treatments, regardless of age.

New medicines are in development that may reduce the risk of cancer recurrence and improve survival after treatment for early breast cancer. The UK regulators and NHS Scotland need strong evidence on the value of new treatments prior to approving medicines as standard care paid for by the NHS.

While clinical trials can provide much of this evidence, there is also a need to provide evidence on the current ‘real-world’ patient population, standard treatments and current outcomes.

The project will generate real world evidence on the current early breast cancer patient pathway. Analysis takes place within the NHS by NHS staff, with only a summary report that does not contain individual patient data being released for the purposes of NHS Health Technology Assessment.

The project output will enable NHS decision makers to make better informed reimbursement decisions on future medicines to ensure the NHS is providing high value care to the patients it serves.

We have recently shown that in patients with symptoms of angina, that a blood test called troponin can predict the severity of a type of heart disease called coronary artery disease. This is where the vessels in the heart have a build-up of fatty tissue that can lead to heart attacks and angina. We do not know if this blood test can be used in other settings to predict the severity of coronary artery disease.

In this study we will look at troponin levels in every patient who attends hospital for an angiogram dye test of their heart arteries, and see if this blood test can predict the severity of heart disease seen on the test. We will also look to see if troponin can predict risk of heart attacks and strokes.

In patients who come for an angiogram, we still don’t know if unblocking the build-up of coronary can help prevent future heart attacks and improve life expectancy. However, we think that a blood test like troponin could be able to tell us which patients at the highest chance of future heart attacks and strokes. This could allow us to avoid doing unnecessary procedures in patients who have a very low risk, and help prioritise tests and intensify medical treatments in patients who will benefit the most.

Project output: 

In August 2023, a journal article was published to share the results of this project: access the journal article 

In conclusion, researchers found that in patients with chronic angina, a blood test called troponin can objectively predict the risk of future heart attack or death independently from cardiovascular risk factors and disease severity. 

As explained in this medical press article, this conclusion suggests that routine troponin testing could help identify high risk patients who require further treatment.

A three-way collaboration between NHS Education for Scotland Digital Service (now called the NHS Education for Scotland Technology Service), NHS Lothian, and the Innovative Healthcare Delivery Programme, as part of a Scottish Government commission to develop a cancer treatment summary.

This is a data-scoping study supporting the NHS Education for Scotland Digital Service team to understand what data is available against the Innovative Healthcare Delivery Programme-defined minimum clinical dataset for cancer treatment summaries in head and neck cancer. The understanding from the project will inform the design and development of a cancer treatment summary to support clinical care and patient communication in this area in the future. This project with DataLoch will deliver an assessment of the data quality, data content and data source.

Project output:

This work was part of the first phase of a Scottish Government commission and informed the technical development of an electronic cancer treatment summary for patients. There is continued commitment to a national approach to cancer treatment summaries: see the cancer action plan 2023-2026 on the Scottish Government website.

White cells produce enzymes which help defeat invading disease-causing organisms. Some of these enzymes may also cause tissue damage and one in particular (elastase) may contribute to the invasion of coronavirus into lung tissue. No existing work has examined the relationship between circulating elastase and severity of coronavirus infection. Should a relationship be identified it opens up the possibility of using inhibitors of elastase as treatments for coronavirus infection. These inhibitors already exist as medical treatments, so they need only to repurposed not developed from scratch.

Patients with COVID-19 can be affected in many ways, many of which are only now coming to light as our knowledge of the virus develops. We know that patients with COVID-19 have an increased risk of cardiovascular complications such as blood clots and heart damage (myocardial injury). We also know that some patients with pre-existing cardiovascular disease, such as previous heart attacks or strokes, have a higher risk of adverse outcomes with COVID. Currently we are unable to tell which patients are at highest risk of these complications.

A European-wide initiative (COVIRNA) is aiming to develop a tool which will then better inform decision making and help clinicians discern who is at highest risk from complications of COVID-19.

In order to develop this tool they will gather pseudonymised data and blood samples of people with and without COVID from 10 centres across Europe, the University of Edinburgh will be one of the centres to provide this information using DataLoch data and samples from NHS Lothian.

Many people with COVID-19 recover quickly and return home, soon able to return to their normal level of function. However, some people become very unwell with COVID, and stay in hospital for a long time. It is important to understand how long people stay in hospital so that we can plan for the future. People may develop complications that need specialist help to return to normal function: rehabilitation. We will describe the rehabilitation needs of people admitted with COVID and the input provided by specialists (physiotherapy, occupational therapy, doctors who specialise in rehabilitation). We will see which aspects of a person’s previous circumstances or health affect their need for rehabilitation, such as their age, frailty or health conditions. We will describe how long people stay in hospital and how they are when they leave hospital, including whether they need more help once they return home.