Ten Key Trials in Cardiovascular Surgery Gavin Murphy On behalf of the Academic and Research Committee of the Society for Cardiothoracic Surgery in Great Britain and Ireland 28th September 2018

CTSN Publications

Patients recruited to multicentre trials in cardiac surgical patients in the UK between 2007 and 2017 Data from published trial reports

Strategy for Academic Cardiothoracic Surgery Academic and Research Committee, 2016. RCS specialty lead, 2017. BHF Strategy Workshop, 2017 Increase in ACF/ ACL posts, 2017. National research meeting, 2017 Change in CCT criteria by SAC 2018. JLI research priority setting exercise, 2018. Trainees research network, 2018. National trials network, 2019.

British Heart Foundation Workshop Programme Surgical Research Monday 13 February 2017 Co-Chairs: Professor Julian Scott (Leeds Teaching Hospitals) and Professor Gavin Murphy (Glenfield Hospital, Leicester & BHF Chairholder)

James Lind Alliance ‘Believes that: Addressing uncertainties about the effects of a treatment should become accepted as a routine part of clinical practice Patients, carers and clinicians should work together to agree which, among those uncertainties, matter most and deserve priority attention.’ http://www.jla.nihr.ac.uk/about-the-james-lind-alliance/

Aims of the Priority Setting Partnership We are looking for the Top 10 priorities in heart surgery research We want to hear the questions of current/previous heart surgery patients, their carers, families and friends, and healthcare professionals If these questions are addressed by researchers, they could help with the progression of modern medicine and be to the benefit of patients

Initial Survey Launched 19th March 2018 at the annual conference for the Society for Cardiothoracic Surgeons (SCTS) in Glasgow Requests patients, carers, families and healthcare professionals to ask questions they wish to be addressed by cardiac surgery research Closes November 2018

On line survey

Number of respondents 419 responses as of August 2018

Type of respondents Among healthcare professional Anaesthetist n = 77 CTS /surgeon n = 32 Intensive care n = 7 Cardiology n = 2

Geography by type of respondents

Examples of submitted questions Area Original questions Submitted by Frail patients What is the long term benefit of complex surgery in frail patients with multiple co-morbidities? nurse Is there anything patients can do prior to heart surgery to help their survival rate? Does prehabilitation improve outcomes in frail patients? doctor, others Fluid management Perioperative fluid management in cardiac surgery. Is fluid restriction strategy benefited to outcome? doctor Antiplatelet Should all patients receive dual antiplatelet agents post CABG if no contra-indications? Diabetic patients Can optimising diabetic control and understanding assist in managing the cardiac disease and reduce post op complications for both staff and patients patient Anaesthetic agent What is the best combination anaesthetic drugs for perioperative myocardial protection? Point-of-care testing Point of care testing vs clinical acumen for the outcome of delayed (ICU) bleeding.

Identifying uncertainties in the literature Sources searched Cochrane database (including Cochrane Heart group) (2010 onwards) NICE Guidance and NICE Research recommendations database BMJ clinical evidence American College of Cardiology the European Society of Cardiology the American Heart Association the European Association of Cardiothoracic surgeons

Outputs Assimilation of literature searches and research questions to identify long-list (December 2018 to February 2019). Second survey for long-list prioritisation (Launch SCTS March 2019). Final prioritisation workshop moderated by JLI (NIHR) with independent observers from major funders, clinical organisations and patients groups. Final 10 recommendations forwarded to NIHR Commissioning Board. Collaboration with Cochrane to define knowledge gaps Autumn/Winter 2019. Funding applications for trial portfolio 2020.

Twitter: @HeartSurgeryPSP Contact details Online survey link: https://leicester.onlinesurveys.ac.uk/heart-surgery-priority-setting-partnership-initial-surve Twitter: @HeartSurgeryPSP

Thank you Any questions?