British Heart Foundation Care and Education Research Group
Background
Our research group has been based in York since 1998. The British Heart Foundation provide support funding for a research fellow and part of Professor Lewin’s salary. The majority of funding is from research contracts from a wide variety of government, charitable and commercial sources.
The group is based in the Department of Health Sciences which attracted 5 rating in the Research Assessment Exercise (RAE). Belonging to this multidisciplinary department gives us rapid access to leading epidemiologists, health economists, statisticians, experts in systematic review and qualitative and quantitative methodologists.
Over the last ten years our work has demonstrably influenced the development of cardiac rehabilitation and NHS policy. Approximately 3,500 healthcare staff have taken part in training programmes that we have devised and we have produced more than 60 peer reviewed scientific papers, chapters or reports.
Strategy
To ‘open up’ clinical and research areas that have been relatively neglected.
To innovate to solve clinical or health service problems of delivery or quality.
To encourage better patient care through demonstrating unmet psychological, social and emotional needs.
To encourage better care through developing multi-disciplinary clinical guidelines and outcome measures.
Guiding principles
To maintain close links with the NHS, clinical networks and patients. All of the staff hold honorary contracts with at least one NHS trust and several have part time clinical contracts. Professor Lewin is the clinical lead for cardiac rehabilitation in the East Riding of Yorkshire.
To work within a biopsychosocial framework. That is to recognise that disability and ill health are only partly related to the underlying lesion and that the patients’ understanding of their illness, the coping measures they adopt, their emotional status, the influence of family and friends and their social settings can also be strong mediators of disability and ill health.
Staff, their professional background and current topic |
Professor Bob Lewin | (Director) | Psychology |
Dr Gill Furze | Nursing | Self-management of chronic disease |
Ms Jill Pattenden | Health Promotion | BHF CHF nurse awards, lay mentors |
Mr Simon Coulton | | |
Mrs Sarah Cockayne | Health Services Research | Evaluation of a home based disease-management programme for
patients CHF |
Dr Nasreen Ali | | |
Dr Mary Madden | | Qualitative research in health and social sciences,
homelessness, cultural and community studies, feminisms |
Ms Corinna Petre | Psychology | Assessment of the Big lottery CR programme |
Mr Hanif Ismail | | Health inequalities, service evaluation, ethinicity, health care |
Ms Sally Baker | | Information Officer |
Miss Nerina Onion | | Information Officer |
Miss Veronica Morton | | Research Fellow in Statistics/Epidemiology |
Mrs Jessica Hemingway | Secretarial | Group Administrator |
Ms Margaret Hope | Secretarial | Angina Plan Secretary |
BHF Care & Education Research Group
Area 4, Seebohm Rowntree Building, University of York, York, YO10 5DD
Contact: Jessica Hemingway jah14@york.ac.uk
Phone: +44 (0) 1904 32 1327 Fax: +44 (0) 1904 32 1388
Some examples of current work
Heart Failure
Jill Pattenden is leading a multi-centred qualitative and quantative evaluation of the impact of 36 newly appointed BHF heart failure nurses. Helen Roberts is developing a shared information tool for clinicians and patients that will address the medical and psycho-social needs of heart failure patients and their partners and carers. One of the unmet needs in this group is palliative care and the research will help us to develop further interventions to help patients who are close to the end of their life.
Angina
Gill Furze and Jenny Robinson are conducting a further study of the Angina Plan, in primary care practices across 5 PCTs in the North and East Riding of Yorkshire and in the 4 in Sheffield and have recently begun the development and evaluation of a ‘pre-habilitation’ programme for patients waiting for bypass surgery. A PhD student, Paul Wathall, in a randomised study using a factorial design, is deconstructing the Angina Plan to determine which of its elements is therapeutically most active.
Paediatric cardiology
Lynne Kendall has been working with the multi-disciplinary paediatric cardiology team at Leeds Heart Centre to develop methods of meeting the needs of children, adolescents and parents. Following on from several projects looking at the views of children’s, parents and NHS staff on how best to deliver care and rehabilitation Lynne is currently examining the value of a ‘physiotherapy outreach’ service working with children, parents and teachers. Yvonne Birks is leading work to develop a quality of life measure for children with heart disease the ConQol and planning a programme of research into the cognitive and behavioural consequences of the illness.
Implanted Cardiac Defibrillators
We have developed and evaluated a hospital-based 6 week rehabilitation programme for ICD patients. This reduced anxiety & depression and led to a significant increase in physical activity and fitness. Many patients were unable to attend and Dorothy Frizelle is currently developing and evaluating through a multicentred RCT, a self-help, home based rehabilitation programme. Other research in this area includes: a national survey of rehabilitation facilities: the development and validation of an ICD misconceptions scale and a study of the incidence of post traumatic stress disorder in these patients.
Clinical Health Psychology
Depression - Depression and Type-D personality have both been associated with early mortality in cardiac patients and we are examining their relationship with mortality following MI and with cardiac arrhythmias in ICD patients. With Dr David Hare we are developing a ‘short form’ of the Cardiac Depression Scale.
Reviews – with the NHS Centre for Reviews and Dissemination we are currently conducting a cost effectiveness review of psychological interventions in cardiac illness and cancer.
Health beliefs and Cardiac Misconceptions - we have developed a model of disability in CHD in which a poor understanding leads to anxiety and the adoption of counter-productive defensive actions. We are examining this model in several groups of patients; in a longitudinal study of the psychosocial predictors of poor outcome following coronary artery bypass surgery, in predicting activity levels in ICD patients and with Professor Terje Murberg of Stavanger in predicting negative findings at angiography.
Some examples of past work
Home, primary care, lay and hospital based interventions
The Heart Manual - a home-based cardiac rehabilitation programme now in use in more than 80 NHS trusts treating around 7,000 patients a year. It has been recommended by the WHO, Scottish Intercollegiate Guidelines Network and the National Service Framework for Coronary Heart Disease. We have used it at the centre of a method for providing rehabilitation equitably across a large geographical area. A scheme that has been appointed as an NHS Beacon.
The Angina Plan - we have developed and evaluated a similar programme for patients newly diagnosed with Angina. This too has been well received by PCTs and Secondary care Trusts and more than 500 nurses have taken the distance training in its use.
Angioplasty workbook - Following requests from clinicians across the country, the Angina Plan has been adapted for use by patients with or without angina, who are awaiting coronary angioplasty - the Angioplasty Workbook.
Heart Failure self-management - for the BHF we are developing a workbook for patients with heart failure for use in primary care
Lay led programmes and Self Help Groups – with the BHF we have been examining the role of patient support groups and the Stanford ‘Expert Patient Programme’.
Clinical guidelines, outcome measures, audit tools
Clinical guidelines - Professor Thompson led the development of the national clinical guidelines and audit tool for cardiac rehabilitation and our work on angina management has been incorporated in the national guidelines for the management of refractory angina.
Minimum dataset for cardiac rehabilitation - we have developed a minimum data-set for cardiac rehabilitation.
HRQOL - we have developed, or are working on, validations of, 3 quality of life questionnaires, the ConQol for children with congenital heart disease, the Cardiac Limitations And Symptoms Profile (CLASP) a measure that can be used across all heart patient groups and the myocardial infarction dimensional assessment scale (MIDAS).
Cardiac misconceptions - patients, relatives, friends and sometimes healthcare staff, have frightening and unhelpful ideas about heart disease and how best to cope with it, we have shown that these can influence the amount of disability reported by patients and have developed misconception scales for myocardial infarction, implanted cardiac defibrillators and angina patients.
Systematic reviews
Cardiac rehabilitation - together with the NHS Centre for Reviews and Dissemination at York we have published a widely cited ‘Effective Healthcare Bulletin’ on cardiac rehabilitation.
Delay in help seeking in acute MI - a systematic review of interventions to reduce delay in summoning medical help in acute MI.
Stages of change interventions - a systematic review of the efficacy of interventions that used this model.
Surveys of the provision of cardiac care and rehabilitation
National surveys of the provision of rehabilitation – we have surveyed the provision of rehabilitation for patients, following MI and revascularisation , with congenital heart disease and ICDs and are currently working with the British Association for Cardiac Rehabilitation and the BHF Health Promotion Research Group at Oxford to map provision of services against need.
Journal articles published since 2003
Dumville JC, MacPherson H, Griffith K, Miles JNV & Lewin RJ. Non-cardiac
chest pain: a retrospective cohort study of patients who attended a
Rapid Access Chest Pain Clinic. Family Practice. 2007 (In Press)
Bethell HJN, Evans JA, Turner SC, Lewin RJP. The rise & fall of cardiac
rehabilitation in the United Kingdom since 1998. Journal of Public
Health (Oxf). 2006 Dec 22, [Epub ahead of print].
Pattenden J, Roberts H, Lewin R. Living with heart failure: patient &
carer perspectives. European Journal of Cardiovascular Nursing (In Press)
Ali, N, Atkin K, and Neal R The role of culture in the general practice
onsultation process Ethn Health. 2006 Nov;11(4):389-408.
Neal R, Ali, N, Atkin, K, Allgar V.L, Ali S, and Coleman T.
Communication between South Asian patients and GPs: Comparative study
using the Roter Interactional Analysis System. British Journal of
General Practice. 2006 Nov;56(532):869-75.
Ismail H, Wright J, Rhodes P, and Scally A, 'Outcomes of quality of care
in diabetes for a patient cohort-attending routine primary care clinics
compared with those attending GP specialist clinics', Diabetic Medicine,
(2006) 23, 851-856
Macran S, Birks Y, Lewin R, Parsons J, Sloper P, Hardman G, Kind P, Van
Doorne C, Thompson D. The development of a new measure of quality of
life for children with congenital heart disease (ConQol). Cardiology in
the Young. 2006 Apr;16(2):165-172.
Orrell AJ, Eves FF, Masters RS. Motor learning of a dynamic balancing
task after stroke: implicit implications for stroke rehabilitation.
Physical Therapy. 2006 Mar;86(3):369-80.
Birks Y, Sloper P, Lewin R, Parsons J. Exploring health-related
experiences of children & young people with congenital heart disease.
Health Expectations. 2006.
Orrell, A.J., Eves, F.F., Masters, R.S.W., & MacMahon, K.M. Implicit
Learning Processes in Stroke. /Neuropsychological Rehabilitation /(in
press).
Neal R, Ali N, Allgar V, Phil H, Leese B, Stage at diagnosis, survival
and diagnostic delays for lung, colorectal, prostate and ovarian cancer:
comparison between patients referred urgently from primary care and
patients diagnosed through other routes. British Journal of General
Practice. 2006 (In Press)
Frizelle DJ, Lewin B, Kaye G, & Moniz-Cook ED. Development of a measure
of the concerns held by people with implanted cardioverter
defibrillators: The ICDC. The British Journal of Health Psychology 2006
May,11(Pt2):293-301.
Orrell AJ, Eves FF, Masters RS. Implicit motor learning of a balancing
task. Gait Posture. 2006 Jan;23(1):9-16.
Kendall L, Parsons JM, Sloper P & Lewin RJP. Determining knowledge of
appropriate activity levels & risk behaviour in young people with
congenital cardiac conditions: a simple screening method for clinics.
Cardiology in the Young (in press).
Furze G, Lewin R, Murberg TA, Bull P, Thompson D. Does it matter what
patients think? The relationship between changes in patients' beliefs
about angina and their psychological and functional status. Journal of
Psychosomatic Research 2005;59:323-329.
Ismail H, Wright J, Rhodes P, and Small N, 'Religious beliefs about
causes and treatment of epilepsy', British Journal of General Practice,
(2005) 55, 26-31.
French DP, Lewin RJP, Watson N, Thompson DR. Do illness perceptions
predict attendance at cardiac rehabilitation and quality of life
following myocardial infarction? Journal of Psychosomatic Research
2005;59:315-322.
Newell R, Ziegler L, Stafford N, Lewin RJ. The information needs of head
and neck cancer patients prior to surgery. Annals of the Royal College
of Surgeons of England 2004;86:407-410
Frizelle DJ, Lewin B, Kaye G, Moniz-Cook E. Development of a new tool
for assessing automatic implanted cardioverter defibrillator patient
concerns: the ICD-TCQ. The British Journal of Health Psychology (in press).
Dunderdale K, Thompson DR, Miles J, Beer S, Furze G. Quality of life in
chronic heart failure: Do we take account of the patient perspective?
European Journal of Heart Failure (in press).
Lewin RJP, Thompson DR, Roebuck A. Development of the BACR/BHF minimum
dataset for cardiac rehabilitation. British Journal of Cardiology
2004;11:300-301.
Murberg T, Furze G. Depressive symptoms and mortality in patients with
congestive heart failure: a six-year follow-up study. Medical Science
Monitor 2004;10:643-8.
Murberg T, Furze G, Bru E. Avoidance Coping Styles Predict Mortality
among Patients with Congestive Heart Failure: A Six-year Follow-up
Study. Personality and Individual Differences 2004;36:757-766.
Frizelle DJ, Lewin RJP, Kaye GC. Provision of rehabilitation services to
patients with implanted cardioverter defibrillators: a survey of UK
implantation centres. British Journal of Cardiology 2004;11:302-305.
Frizelle DJ, Lewin RJP, Kaye G, Hargreaves C, Hasney K, Beaumont N,
Moniz-Cook E. Cognitive-behavioural rehabilitation programme for
patients with an implanted cardioverter defibrillator: a pilot study.
British Journal of Health Psychology 2004;9:381-392.
Kainth A, Hewitt A, Pattenden J, Sowden A, Duffy S, Watt I, Thompson D,
Lewin R Systematic review of interventions to reduce delay in patients
with suspected heart attack. Extract. British Medical Journal 2004;90:1161.
Kainth A, Hewitt A, Pattenden J, Sowden A, Duffy S, Watt I, Thompson D,
Lewin R Systematic review of interventions to reduce delay in patients
with suspected heart attack. Emergency Medicine Journal 2004;21:506-508.
Neal RD, Ali N, Allgar V, Coleman T. Consent rates for video-recording
general practice consultations: effect of ethnicity and other factors.
Family Practice. 2004 21: 213-218.
Furze G, Bull P, Lewin RJP, Thompson DR. Development of the York Angina
Beliefs Questionnaire. Journal of Health Psychology 2003;8:307-316.
Martin CR, Lewin RJP, Thompson DR. A confirmatory factor analysis of the
hospital anxiety and depression scale in coronary care patients
following acute myocardial infarction. Psychiatry Research 2003 Aug
30;120:85-94.
Lewin RJ Cardiac rehabilitation and primary care. The Practitioner 2003
March;247:220-2,224.
Lewin RJP, Furze G, Robinson J, Griffith K, Pye M, Boyle R. A simple
self-help treatment manual can reduce angina and improve health related
quality of life. Geriatric Medicine 2003 Jan:45-48.
Kendall L, Sloper P, Lewin RJP, Parsons JM. The views of young people
with congenital cardiac disease on designing the services for their
treatment. Cardiology in the Young 2003 Feb;13:11-9.
Kendall L, Sloper P, Lewin RJP, Parsons JM. The views of parents
concerning the planning of services for rehabilitation of families of
children with congenital cardiac disease. Cardiology in the Young 2003
Feb;13:20-7.
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