Transforming heart failure treatment

A research project by a PhD student in the Division of Medicine and Therapeutics could have a significant impact on the way heart failure patients are treated in the future.

Dr Matlooba AlZadjali's study found that a drug considered unsafe in heart failure patients was in fact beneficial.

"Metformin is contraindicated in heart failure patients although some GPs do prescribe it," explained Dr AlZadjali. "It is widely used in the treatment of Type 2 diabetes but caution has been raised regarding its use in chronic heart failure.

"This is largely due to the historical experience of lactic acidosis with phenformin, which is from the same drug family, even though metformin does not predispose to this when compared with other therapies.

"I wanted to look at whether it is safe or not and I found that it is. It improves patients' clinical outcomes."

Matlooba's study, which used information from the Health Informatics Centre and the Diabetes Audit and Research in Tayside Scotland (DARTS) database, has been recognised by the American Society for Clinical Pharmacology and Therapeutics with a prestigious Presidential Trainee Award.

As part of the award Matlooba, who holds a BSc and an MD from the Arabian Gulf University of Bahrain and a Master of Public Health from Dundee, has been invited to attend the ASCPT's annual conference in Orlando in April to showcase her abstract.

"I'm really looking forward to going to the conference," she said. "I have presented in the USA before but going there for this award is really different. I won prizes while I was at medical school but this one is very prestigious and it is great for me and the department to have the work we are doing recognised in this way."

Matlooba's PhD supervisor Professor Chim Lang believes her research could have major consequences for the way heart failure patients are treated.

"The potential impact of the project is huge," he said. "Metformin is a cheap, generic drug and chronic heart failure is a major public health problem in the world which means that metformin has the potential to be not only highly effective in terms of the number of patients "saved" but also highly cost effective because metformin is relatively such a cheap therapy."

The research project is part of Matlooba's doctoral research on insulin resistance in heart failure which she hopes to finish next year. After that she plans to return home to Oman to begin work on realising her dream of establishing a heart failure service there.

"Patients are treated at the moment but there is no specific service like here is there where community nurses follow-up patients at home and offer advice and education," she explained. "There is a big emphasis on preventative treatment here. It is a big public health issue here and it is the same in Oman. Life expectancy is increasing and heart failure is becoming more prevalent. I want to combine my clinical and research skills with my public health experience to make a difference. I will have to find a team to work with and I know it will be a big challenge but I want to help people and I think this is the best way for me to do this. It has always been my motivation and it is why I became a doctor in the first place."

Matlooba will be presenting her winning abstract entitled "Metformin use is associated with markedly lower clinical outcomes in patients with heart failure and type II diabetes" at e the ASPCT Annual Meeting in Orlando on 2 April.