The ASPIRE project has been generously funded in memory of Betty Carr.
Why is this research needed?
Up to 1 in 25 adults in the UK have a type of irregular heartbeat called atrial fibrillation, also known as a-fib or AF. People with AF have a five times greater risk of stroke than someone without. Fortunately, it is possible to reduce this risk by taking drugs that prevent blood clots. You can read more about how AF is diagnosed and treated on our information page about atrial fibrillation.
However, many people with AF are not aware that they have an irregular heartbeat, so they may not seek medical help.
While we could catch more cases of AF by asking everyone to have a regular heart check-up, the UK National Screening Committee (a national body which provides expert advice on medical screening) does not recommend this approach. This is for two reasons: it would be expensive to establish a mass screening programme and there is currently no evidence one way or another about whether such a programme would help prevent more people with AF from having a stroke.
The ASPIRE team think there is another way forward: creating an AF risk score that will allow targeted screening of people who are most likely to have AF.
What are the aims of this research?
We already know several risk factors for someone developing AF, which include:
- Medical conditions like high blood pressure and heart disease
- High levels of a blood marker called NTproBNP, which is released by the heart muscles when they are having to work particularly hard
- Certain signs on an ECG (electrocardiogram) heart test
- Particular genes that are associated with developing AF
The ASPIRE team will, for the first time, attempt to combine all of these into a single risk score that could potentially be used by healthcare professionals to decide who should be screened for AF.
First, they will develop a mathematical model that combines these different risk factors into one AF risk score using data from the Generation Scotland study. Generation Scotland contains health information from nearly 22,000 adults of all ages, including all of the risk factors above. Some medical conditions like diabetes carry an increased risk of AF, so they’ll also be developing mathematical models to be used specifically with people who have those conditions.
Next, they will need to ensure that the risk score works not just for Generation Scotland participants but can also predict AF risk in other people. To do this, they will test their AF risk score against data from the UK Biobank, which is a much larger biomedical database, containing information from about half a million people in the UK.
Finally, they will look at cost-effectiveness. If the AF risk score is adopted across the UK, many more people will be aware they have AF and will need monitoring and treating. Persuading the NHS and government to move to risk-based AF screening requires a sound economic argument of the benefits, so the team will analyse the expected financial gain of using the AF risk score to guide AF screening, and will also work out the likely financial benefits of further research in this area, such as adding further risk factors to the mathematical model.
What is the benefit of this research?
If they’re successful in developing an AF risk score, the ASPIRE team plan to push for it to be implemented across the UK and internationally. In the near future, this would mean more people get screened and treated for AF. In the longer term, that translates to many fewer people having to experience the devastating effects of stroke, whether that is losing a loved one to stroke or dealing with the physical, mental, emotional and financial consequences of surviving a stroke.
What PSP priorities does this research link to?
From 2019 to 2021, we worked with the James Lind Alliance on the Stroke Priority Setting Partnership (PSP). During the PSP process, we collaborated with people with lived experience of stroke and stroke professionals to find out what they thought were the top priorities in stroke research. From this, we identified the top ten priorities in two areas: prevention, diagnosis and short-term care, and rehabilitation and long-term care.
Now, when researchers apply to us for funding, we require that their work addresses at least one of these priorities, or a priority from the Childhood Neurological Disabilities PSP Top 10 as it relates to childhood stroke.
ASPIRE addresses the following priority:
- Prevention 1: Stop stroke from happening for the first time (primary prevention).
Meet the team
ASPIRE is led by Dr Alan Cameron, Honorary Clinical Lecturer in the School of Cardiovascular and Metabolic Health at the University of Glasgow, and Specialty Registrar in Stroke Medicine at NHS Greater Glasgow and Clyde.
The other members of the team are:
- Jesse Dawson, Professor of Stroke Medicine at the University of Glasgow Consultant Physician at the Queen Elizabeth University Hospital. Jesse supports Alan in overseeing ASPIRE, as well as helping to interpret the findings and share the results with the stroke community. We have previously funded Jesse on other projects, including the ELAN clinical trial which showed that blood thinners to reduce the risk of current stroke can be safely given to patients with AF much sooner after stroke than previously thought possible.
- Professor Gregory Lip, Price-Evans Chair of Cardiovascular Medicine and Director of the Liverpool Centre of Cardiovascular Science at the University of Liverpool. Gregory oversees the ECG elements of ASPIRE, which require the use of artificial intelligence. He also helps interpret findings and share the results with the stroke community. Gregory is also PhD supervisor to Dr Josie Mayer, a Stroke Association-funded researcher working on the links between seizures and stroke.
- Yalin Zheng, Professor of Artificial Intelligence in Healthcare at the University of Liverpool. Yalin works with Gregory to oversee the ECG elements of ASPIRE.
- Dr Caroline Haig, a Biostatistician at the University of Glasgow. Caroline leads on statistical analyses for ASPIRE.
- Dr Paul Welsh, a Reader in Cardiovascular and Metabolic Health at the University of Glasgow. Paul leads the analysis and interpretation of NTproBNP levels.
- Sandosh Padmanabhan, Professor of Cardiovascular Genomics and Therapeutics at the University of Glasgow. Sandosh leads the analysis and interpretation of genetic data.
- Robert Heggie, a Research Associate at the University of Glasgow. Robert leads the analysis of economic costs and benefits of adopting the AF risk score to guide AF screening.
- Jeremy Dearling, the team’s patient and public involvement (PPI) representative. Jeremy uses his personal experience of stroke to help guide the progress of the project, interpret findings, and share results with the stroke community.
- Ozzy Dincarslan, the study administrator at the University of Glasgow. In the early stages of the study, Ozzy scanned ECGs from the Generation Scotland databank into a digital format.
Later in the project, the team will be joined by a postdoctoral research associate who will work with Gregory and Yalin to develop artificial intelligence approaches to analyse the ECGs, and a statistician and technician who will work with Caroline to help to develop the risk model.