My research work has delivered crucial impacts in changing national and international clinical practice guidelines and improvements in patient care within three principal areas: (i) treatment decisions related to stroke and bleeding risk in atrial fibrillation (AF), which is the commonest cardiac arrhythmia in the general population, (ii) screening practice in primary care, and (iii) stroke and bleeding risk assessment.
My research impact on improvements in healthcare is summarised in a University of Birmingham 2014 Research Excellence Framework (REF) Impact Case Study: http://impact.ref.ac.uk/CaseStudies/CaseStudy.aspx?Id=38790
I was selected to the Thomson Reuters Science Watch list of ‘World’s Most Influential Scientific Minds 2014’, a ranking of today’s top global 17 scholars who have published the greatest number of hot papers, ranked in the top 0.1% by citations, [issued June 2014]. In 2013, I was also selected to the Thomson Reuters Science Watch list of “Who and What was Hot in Scientific Reseach in 2012” (issued June 2013) which lists the most influential scientific researchers and research papers of the year.
I am listed as Highly Cited Researcher [2014, 2015, 2016, 2017, 2018], representing the top 1% most cited for their subject field [http://highlycited.com], representing the list of the world’s most influential scientists whose work has been consistently judged by their peers to be of particular significance, ie. being the top 1% most cited for their subject field and year of publication.
In January 2014, I was ranked by Expertscape as the world's leading expert in the understanding and treatment of AF, and correspondingly, the University of Birmingham listed as the world's top institution for AF research [See http://www.prlog.org/12273752-expertscape-ranks-top-doctors-and-hospitals-in-atrial-fibrillation.html]. My global top ranking is still maintained in March 2018 [see http://expertscape.com/ex/atrial+fibrillation]
My work into improving AF clinical management won the Heart Rhythm UK ‘Arrhythmia Alliance Team of the Year Award 2012' and the BMJ Group ‘Cardiovascular Team of the Year 2013’ award
I received the 2016 National Institute for Health Research (NIHR) CRN West Midlands Clinical Research Impact award; for atrial fibrillation research, September 2016
July 2017, West Midlands Academic Health Sciences Network Celebration of Innovation ‘Excellence in Wellness and Prevention Award’ Winner for “Birmingham 3 step approach” Prof GYH Lip/Dr S Sarwar: University of Birmingham and Sandwell and West Birmingham Hospitals NHS Trust.
October 2017, Anticoagulation Achievement Awards ‘Centre best able to demonstrate adherence to NICE Quality Standards for Atrial Fibrillation’ for work on ‘Birmingham 3-step approach’ with Sandwell West Birmingham Clinical Commissioning Group; Also, Atrial Fibrillation Association (AFA) Healthcare Pioneers 2018 ‘Streamlining primary and secondary care management pathways for stroke prevention in atrial fibrillation.’
March 2018 Conferred Honorary Fellowship of AIAC (Associazione Italiana Aritmologia e Cardiostimolazione) [FAIAC] “in consideration of … landmark contributions in the field of atrial fibrillation”
Awarded National Institute for Health Research (NIHR) Senior Investigator status (2017-2020) in open competition.
In 2018, honoured as Distinguished Professor by Aalborg University, Denmark [the first appointment for that University; inaugural lecture on 14 November 2018]
November 2018, Atrial Fibrillation Association (AFA) Healthcare Pioneers 2019 winner ‘An Integrated Approach To Streamline Atrial Fibrillation Management In A Holistic Manner: The ABC (Atrial fibrillation Better Care) Pathway; https://bit.ly/2zsxvDF)
Example: Atrial fibrillation clinical management
With regard to clinical management, clinical risk scores developed and validated by my work to assess stroke & bleeding risk in atrial fibrillation (AF) (ie. CHA2DS2-VASc & HAS-BLED) are used in national/international management guidelines, eg. UK National Institute for Health & Care Excellence (NICE, 2006 & 2014), European Society of Cardiology (ESC 2012, 2016), Canadian Cardiovascular Society (2012), Asia Pacific Heart Rhythm Society (APHRS 2013, 2017), American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines (2014), American College of Chest Physicians (CHEST) guidelines, etc.
The CHA2DS2-VASc score helps clinicians formally assess stroke risk and identify `truly low risk' patients who do not need antithrombotic therapy, and effectively captures those patients who should be considered for stroke prevention. Risk assessment with CHA2DS2-VASc is part of the NICE Quality Outcomes Framework (QOF) and is easily available for use by GPs as part of the Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) risk stratification tool, available and compatible for use with all GP clinical systems in England. The simple, user-friendly HAS-BLED score, comprising risk factors either readily available from the clinical medical history or routinely tested in (new) patients, allows clinicians to formally assess bleeding risk, focusing on modifiable bleeding risk factors and those who require regular review (patients at higher bleeding risk).
My development of SAMe-TT2R2 score (2013) aids decision-making between warfarin and new anticoagulants. This score is used in the 2018 CHEST guidelines, ESC/NICE consensus recommendations, Clinical Commissioning Group (CCG) for AF (2014) and the PRIMIS Warfarin Patient Safety audit tool (2014). The CHA2DS2-VASc, HAS-BLED and the SAMe-TT2R2 scores are now part of the CCG AF patient pathway streamlining decision making and improving the primary-secondary care interface (the ‘Birmingham 3-step’ AF pathway, 2016). The latter forms the basis of the West Midland Academic Health Science Network (AHSN) ‘Preventing AF related Strokes’ initiative (2017), followed by Primary Care Clinical Pathway for Atrial Fibrillation Detection & Management issued by the WMAHSN and Public Health England https://bit.ly/2FhrwXQ). I proposed and validated an integrated and holistic approach to AF management as the ABC (Atrial fibrillation Better Care) pathway, which is adopted in the WMAHSN Primary Care Pathway, and used in the 2018 CHEST guidelines and 2018 Korean Heart Rhythm Society guidelines on AF management.
My overall clinical research work into AF has also had a major impact on recommendations in AF guidelines issued by NICE (2006 and 2014), as well as the ESC (2010, 2012 and 2016), CCS (2011) and ACCP (2012, 2018). My research has informed European consensus guidelines on the optimal management of anticoagulated AF patients who present with an acute coronary syndrome ± undergo coronary intervention/stenting (ESC, 2010, 2014, 2018), as well as the assessment/management of bleeding in AF patients (European Heart Rhythm Association (EHRA), 2011).
Example: The prothrombotic state in cardiovascular disease
The concept of ‘atrial fibrillation is a prothrombotic or hypercoagulable state’ was first proposed by myself in a Lancet article in 1996. My ongoing work has validated biomarkers of thromboembolism and vascular biology in cardiovascular disease (esp AF) as prognostic indices, and such biomarkers have been used in the assessment and investigation of AF, and the study of new antithrombotic drugs by industry (various ongoing studies, 2009-), as surrogate biomarkers of clot formation in AF.