Research project
CROSS sectional versus invasive imaging in patients with Heart Failure (CROSS-HF)
- Start date: 1 October 2024
- End date: 1 April 2029
- Funder: National Institute for Health and Care Research (NIHR)
- Value: £1,955,044
- Partners and collaborators: University of Glasgow, University of Leicester
- Primary investigator: Dr Peter Swoboda
- Co-investigators: Professor John Greenwood, Honorary Professor of Cardiology Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Email: j.greenwood@leeds.ac.uk
- External co-investigators: Professor Colin Berry, Professor Mark Petrie, University of Glasgow; Professor Gerald McCann, Professor Iain Squire, University of Leicester; Dr Jonathan Weir McCall, University of Cambridge. Health Economics: Robert Heggie, Professor Olivia Wu, University of Glasgow.
- Postgraduate students: Charity Partner: Cardiomyopathy UK
Description
Each year in the UK at least 60,000 patients are diagnosed with heart failure. Coronary artery disease (narrowing of the blood vessels supplying the heart) is the most common cause of heart failure. It is important to identify coronary artery disease because these patients have increased risk of dying and may respond less well to modern treatments. Invasive coronary angiography (described below) is often done as the first line test to identify coronary artery disease in a fifth of patients with heart failure in the UK. However, we know from work with our patient and public involvement groups and patient charities (including British Society for Heart Failure Patient Group and Cardiomyopathy UK) that most patients would prefer to avoid invasive coronary angiography if possible.
The trial
The trial
The aim of this trial is to establish if it is possible to reduce the need for invasive angiography in patients with newly diagnosed heart failure. 3000 patients presenting with a new diagnosis of heart failure and not known to have coronary artery disease will be recruited. They will be randomly assigned (equal chance) to one of three tests:
1. Invasive coronary angiogram (current NHS practice)- A specialised X-ray test where dye is injected directly into the heart arteries via the groin or wrist. It carries a small risk of serious complications such as stroke. The test exposes patients to radiation and is expensive (NHS tariff up to £1563). Furthermore, there are long waiting lists for the test following many cancellations due to the COVID-19 pandemic.
2. CT coronary angiography - this test is quick, non-invasive and cheaper than invasive angiography (NHS tariff up to £310). It has a high accuracy for detection of coronary artery disease but can be challenging in certain patient groups such as elderly patients or those with irregular heart rhythms. It also exposes patients to a small dose of ionising radiation.
3. Stress cardiovascular MRI - This test is non-invasive and cheaper than invasive angiography (NHS tariff up to £596) and provides additional information on the structure and function of the heart. The accuracy of this test for detection of coronary artery disease is unproven in patients with heart failure. It does not expose patients to ionising radiation.
Patient recruitment
We will maximise recruitment of patients who have been poorly represented in heart failure trials: including elderly, ethnic minority and socio-economically disadvantaged patients. We will reduce barriers to participation and work with the NIHR ethnic minority research inclusivity group to develop a YouTube video explaining the rationale of the trial and the importance of participation. The video will be in plain language and will be available in a variety of languages.
We have designed the trial to minimise inconvenience to patients without any additional hospital visits. All follow up will be done remotely mainly by review of electronic health records. Surveys to explore patient experience will be sent out online, by text message or post according to patient preference. We will work out whether these tests are good value for money for the NHS.
The team
Dr Peter Swoboda
Associate Professor in Cardiology
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT
Email: P.Swoboda@leeds.ac.uk
Professor John Greenwood
Honorary Professor of Cardiology
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT
Email: j.greenwood@leeds.ac.uk
Professor Colin Berry
Professor of Cardiology and Imaging
School of Cardiovascular and Metabolic Health, BHF Glasgow Cardiovascular Research Centre, 126 University Place, University of Glasgow, G12 8TA
Email: colin.berry@glasgow.ac.uk
Professor Mark Petrie
Professor of Cardiology
Institute of C&MS, BHF GCRC, University of Glasgow, G12 8TA
Email: mark.petrie@glasgow.ac.uk
Professor Gerald McCann
NIHR Research Professor and Professor of Cardiac Imaging
Department of Cardiovascular Sciences, University Rd, University of Leicester, LE1 7RH
Email: gpm12@leicester.ac.uk
Professor Iain Squire
Professor of Cardiology
Department of Cardiovascular Sciences, University Rd, University of Leicester, LE1 7RH
Email: is11@leicester.ac.uk
Dr Jonathan Weir McCall
Department of Radiology, School of Clinical Medicine, University of Cambridge, CB2 0SP
Email: jw2079@cam.ac.uk
Health Economics
Robert Heggie
Research Associate
School of Health & Wellbeing, Clarice Pears Building, 90 Byres Rd, University of Glasgow, G12 8TB
Email: robert.heggie@glasgow.ac.uk
Professor Olivia Wu
William R Lindsay Chair of Health Economics
School of Health & Wellbeing, Clarice Pears Building, 90 Byres Rd, University of Glasgow, G12 8TB
Email: olivia.wu@glasgow.ac.uk
Charity Partner
Cardiomyopathy UK
For medical professionals
Protocols
Funding Links
For patients
lay summary here
Links
Cardiomyopathy
https://www.cardiomyopathy.org/
British Society for Heart Failure
https://www.bsh.org.uk/
Impact
If this trial shows that non-invasive imaging tests are no worse than invasive angiography then we will be able to reduce the thousands that are done each year in the NHS. We hope this will lead to improved patient experience and cost savings without affecting the health of patients with heart failure.