TARGET-Type 2: A pilot randomised controlled trial
Research type
Research Study
Full title
Targeting investigation and treatment in patients with type 2 myocardial infarction (TARGET-Type 2): A pilot randomised control trial
IRAS ID
310213
Contact name
Andrew Chapman
Contact email
Sponsor organisation
University of Edinburgh
Clinicaltrials.gov Identifier
NCT05419583
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Summary Of Research
We are doing this study to find if we can improve the treatment of patients who have an injury to their heart muscle when the heart is put under stress. The medical term for this is ‘type 2 myocardial infarction’. Unlike a heart attack, which happens due to a blocked heart artery (a ‘type 1 myocardial infarction'), in this condition there are no heart artery blockages. The heart can be damaged if it beats too quickly, or if blood pressure or oxygen levels are too low. Often this happens during another illness or condition.This condition is common and patients are at increased risk of future heart disease. Our research has shown that most patients who experience heart muscle damage during another illness also have undiagnosed heart disease such as narrowed blood vessels or a weakened heart muscle. Currently, we don’t know which treatments help people with this type of heart injury and there are no guidelines.
Our research project will perform extra scans and blood tests to see if we can identify underlying heart disease which may benefit from treatment. This treatment will be with commonly used medications, known to be beneficial in the treatment of patients with heart attacks due to a blocked artery. We hope to prevent patients with type 2 myocardial infarction having a future heart attack and prolong their life by improving their medical care.
We plan to recruit 60 patients; 30 will receive usual care and 30 will receive usual care plus our tailored investigation and treatment recommendations. The results of this study will allow us to design a much larger study that will take place across many different hospitals in multiple countries. We also wish to gather information on what people think about taking part in the study.
Summary of Results
Sometimes when patients are unwell, the heart doesn't get enough oxygen. Unlike in a typical heart attack, this is not because of a blocked artery, but because the person is very sick. This condition is called a type 2 myocardial infarction. These events are are common and can lead to worse outcomes. Doctors do not have clear guidelines for further tests or treatment.A team of researchers from the University of Edinburgh conducted a study to explore how to better treat these patients. They tested whether specific heart investigations found heart artery disease or heart muscle weakness, and started treatment. This was a small pilot randomised controlled trial to check if their methods worked before a larger study.
The team screened 403 patients with a type 2 myocardial infarction, 120 patients were approached and 60 agreed to participate in the study.
Patients were randomised in two groups.
Intervention Group: These patients received a detailed investigation of their heart health. Depending on their needs, they had tests like CT scans or echocardiograms to look at their heart and were given treatments including medication to lower cholesterol or thin the blood.
Standard Care Group: These patients received usual hospital care, which varied depending on their doctor's decisions.
Results
The study found that it was feasible to recruit and randomise patients for this type of study. Patients in the intervention group generally received more tailored investigations and treatment, and adherence to treatment was high. Both groups had similar rates of follow-up investigations and medication prescriptions by the end of the trial, but the specialised group had more specific recommendations.What Patients Thought
Most patients joined the study to help improve medical knowledge. They appreciated the care but noted that the term "type 2 heart attack" was not well explained by healthcare providers. This led to some confusion and anxiety, highlighting a need for better patient education.Conclusions
The researchers concluded that it's possible to identify and treat patients with type 2 myocardial infarction in a more structured way. Future trials should standardise investigations like heart scans. This approach has the potential to prevent future heart issues for these patients.Importantly, the study showed that more support and resources are needed to help patients understand this condition better. Educating patients with clear and accessible information is crucial to improving their experience and health outcomes.
Next Steps
A larger trial is needed to confirm these findings and to establish better treatment guidelines. By focusing on understanding and treating these conditions early, doctors can improve the long-term health of patients.In summary, this pilot study represents a step forward in tailoring heart care for those with type 2 heart attacks, with an emphasis on greater patient education and structured treatment plans.
REC name
North of Scotland Research Ethics Committee 1
REC reference
22/NS/0085
Date of REC Opinion
15 Jul 2022
REC opinion
Further Information Favourable Opinion