Research Investigator Network

Empowering heart failure research.

Latest research trials and projects

Study title: IDEAL-HF: Implantable Defibrillator Early Alternative to Late in Heart Failure patients 

Sudden Cardiac Death (SCD) remains a leading cause of mortality in patients with heart failure and reduced ejection fraction (HFrEF) despite better medical therapy. Implantable cardioverter-defibrillators (ICDs) are used to reduce SCD risk, but they carry risks and significant costs. Current guidelines recommend ICD implantation for patients with persistent severe left ventricular systolic dysfunction (LVSD) despite ≥3 months of optimal doses of guideline-recommended medical therapy (GRMT). Emerging evidence suggests that prolonged GRMT may improve left ventricular function in more patients, potentially reducing the need for ICDs. 

The aim of the study is to determine whether delayed reassessment of left ventricular function in patients with an ejection fraction (EF) ≤35% who are on optimised doses of guideline recommended medical therapy (GRMT): 

1. Leads to a reduction in the number of patients eligible for primary prevention ICD therapy 

2. Is safe i.e. delaying reassessment and ICD implantation does not lead to an increase in SCD or cardiac arrest. 

  • Patients with persistent severe LVSD (EF ≤35%) despite ≥3 months of optimised GRMT who are eligible for a primary prevention ICD 

  • Patients will be randomised to either: 

    1. standard treatment i.e. immediate referral for ICD implantation as per current guideline recommendations  

    or  

    1. delayed reassessment of EF after a further 9 months of optimal GRMT (i.e. at least 12 months in total), with ICD implanted if still fulfils eligibility criteria at that stage 

  • Successful pilot study complete, grant application for RCT in progress.  

  • If you are a heart failure and/or complex devices specialist with an interest in helping to answer the question “when is the optimal time to reassess EF prior to implanting a primary prevention ICD”? then please do make contact.

    We are aiming to make this a UK-based multicentre trial and will need interested sites to recruit patients, as well as experts to help guide delivery via a steering committee. 

For further information please contact

Dr Matthew J Dewhurst, Northumbria Healthcare Trust

Matthew.dewhurst@nhs.net 

Study title: ARISE: Atherosclerotic Renovascular Disease, Investigation, Synthesis and Engagement

Atherosclerotic renovascular disease (ARVD) manifesting as renal artery stenosis is present in up to 54% of patients attending heart failure clinics, contributes directly to heart failure pathophysiology, and observational evidence supports benefit from revascularisation in this group. However, ARVD is not routinely considered in heart failure services.

Efforts to establish a trial of renal artery revascularisation in high-risk phenotypes including heart failure have stalled because existing trials enrolled predominantly lower-risk patients and their negative results have been broadly extrapolated to all ARVD, shifting the clinical narrative away from revascularisation. A UK Kidney Association survey of 40+ centres confirmed wide practice variation and caseloads too low to sustain trial recruitment. Without a clinical care pathway to identify and refer high-risk patients, trial recruitment cannot be established.

ARISE will undertake evidence synthesis and convene multi-specialty experts to produce the first UK clinical guidelines for ARVD, deliver an active implementation programme, and establish a national registry to monitor practice change.

  • Patients with severe ARVD (≥70% stenosis) and high-risk phenotypes including heart failure, refractory hypertension, or rapidly progressive CKD will be enrolled through nephrology and heart failure clinics at 8–12 UK sites.

  • GRADE evidence synthesis; formally endorsed guidelines; co-produced implementation package; national prospective registry with HES/ONS linkage evaluated by interrupted time series.

  • RfPB Stage 1 outline in preparation. An ARISE Expert Working Group (EWG) is being established.

  • Representation from the heart failure community and BSH is actively sought for the EWG. Clinicians at potential registry sites and those with expertise in haemodynamic significance assessment are encouraged to make contact.

  • A separately funded haemodynamic significance substudy (e.g. translesional pressure, BOLD MRI, parenchymal volume/single-kidney GFR ratio, RAASi intolerance, phenotype and severity alone) is planned using the ARISE registry as its platform.

For further information please contact

Professor Darren Green, Salford Royal Hospital & University of Manchester

darren.green@nca.nhs.uk

BSH Fellowship programme

The BSH Fellowship provides funding for heart failure research leading to a potential higher level qualification. It exists to inspire new, talented researchers to bring their ideas to life.

Find out more and apply here.

Our Research Investigator Network sits under our Research Forum.

The RIN is keen to engage with individuals interested in conducting heart failure research. They can provide advice to help develop your research potential and support with clinical trial recruitment.

For endorsement of research projects, please download the form HERE

For more information, please contact us at info@bsh.org.uk