A University of Birmingham team is building a global research network to improve how atrial fibrillation—a common heart rhythm disorder that raises stroke risk—is diagnosed and managed in low- and middle-income countries, particularly among impoverished populations in China and Brazil. Atrial fibrillation affects millions worldwide, but most research and treatment guidelines come from wealthy nations. In poorer settings, the condition is often undiagnosed, untreated, or managed with outdated methods. This project addresses that gap by pairing Birmingham’s world-leading expertise in AF epidemiology, stroke prevention, and integrated care with local knowledge from partner countries. If successful, the work could reshape clinical practice in underserved regions—reducing strokes, hospitalisations, and deaths from a largely preventable condition. It may also build lasting research capacity, training local clinicians and researchers to sustain improvements long after the grant ends. The team’s track record includes trials that have shaped UK and international guidelines, so the findings are likely to influence policy beyond the immediate partner countries.
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University of Birmingham (UoB) has global ambitions around its reach and research impact, based on effective engagement, collaboration and partnerships to inform, utilise and contextualise its research. UoB has world-leading experts in AF management, and strengths in the improvement of ambulatory and local health care. Various global research studies into AF epidemiology and management are ongoing (Lip, Lane, Kirchhof). This, in partnership with LMIC counterparts’ regional expertise, can be co-developed to synergistically achieve a global impact on the management of AF and its direct health benefits to patients with this condition. Alongside this broad strategy UoB also supports focused engagement in several key strategic regions including China and Brazil (2 of our bid partners, although our focus will be on impoverished populations in these settings), to develop research to improve care and reduce inequalities. Moreover, UoB is investing in a new Institute for Global Innovation and Development (IGID), which brings together multidisciplinary research to address the most pressing global challenges. The Institute of Applied Health Research (IAHR) has a growing international reputation in a number of health themes and methodologies including epidemiology, biostatistics, health economics, systematic reviews, qualitative research and clinical trials. These existing investments are complementary to this proposal. In collaboration with clinicians and scientists IAHR delivers translational applied health changes to improve care, for example in COPD, obesity (behaviour change) and CVD management (Jolly, Lasserson, Manseki-Holland, Thomas). Cheng established one of the first academic GP departments in China. We have worked with International NGOs, WHO and UNICEF on designing and delivering country based programmes, health systems reform, adaptation and the development of complex health care and health promotion interventions, including delivery of quality health services from village to provincial hospital level in 3 provinces in Afghanistan and 2 in Tajikistan (Manseki- Holland). The present proposal builds on these multidisciplinary strengths and initial links with our partner countries, and would improve research capacity in the latter, with access to our multidisciplinary AF expertise. The Institute of Cardiovascular Sciences(ICVS) has a global reputation in AF research ranging from AF epidemiology and pathophysiology (Lip, Lane); novel mechanisms (Kirchhof); improvements of AF patient care pathways, incl. stroke/bleeding risk assessments, optimizing thromboprophylaxis, etc (Lip, Lane); and clinical trials (BCTU, Lip, Kirchhof). ICVS are involved in ongoing and published guideline-shaping AF trials and lead several international projects (MRC, Leducq Foundation, NIHR, BHF, EU H2020) aiming at improving AF management in HICs. Research from our group has informed national (NICE) and international AF management guidelines (ESC, ACCP, APHRS) and has helped to inform patients and the public about AF, its consequences, and therapy. Together the Institutes have delivered a programme of clinical trials within the UK in AF including: • The only randomized trial of community AF screening (SAFE(1); Lip, Jowett) • BAFTA, the Birmingham AF Treatment of the Aged trial(2) (Lip, Jowett) • Cardiovascular rehabilitation post-MI (BRUM trial(3)) and heart failure (BRUM-CHF(4)) which included integrated care that involved lifestyle modification and exercise (Jolly, Lip, Lane) IAHR and ICVS research capacity (300 staff) allows expertise to be drawn on when required, and high research income aids with the retention of expertise. IAHR also hosts the NIHR Global Health Research Group COPD and NIHR Global Health Unit for surgical clinical trials. These networks provide invaluable opportunities for shared learning and growth in research capacity for global health research. Post award support and delivery expertise fr
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