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Dr Eduardo Coutinho
Dr Alena Shantsila
Prof GYH Lip
No more applications being accepted
Self-Funded PhD Students Only
About the Project
Atrial fibrillation (AF) is a common cardiac arrhythmia characterized by irregular and often rapid electrical activity in the atria of the heart due to a disruption to the normal coordinated contractions1. AF causes irregular heartbeats and inefficient blood pumping, leading to symptoms such as palpitations, shortness of breath, fatigue, and dizziness. AF increases the risk of stroke, heart failure, other cardiovascular complications and mortality. Moreover, living with AF has a negative impact on mental health, related to increased anxiety (concerning AF episodes and their consequences; and depression2. As a result, around 60% of people with AF have impaired health-related Quality of Life (HRQoL) which is also affected by (and affects) symptom burden and psychological function and an increased risk of mortality3. AF also poses a substantial economic burden on healthcare systems due to its high prevalence, frequent hospitalizations, and the need for long-term management4. Just in the United Kingdom, the estimated number of AF patients in 2016 was circa 2.16 million (~1.76%)5.
Whereas any individual can develop this condition, AF can be influenced by various risk factors that can be classified as ‘wear-and-tear’ (associated with ageing, diet, lifestyle-related habits and other medical conditions), congenital and genetic predispositions6. On a population-wide basis, hypertension (HT) is the most common aetiological factor linked to AF with a major impact on the pathogenesis, management, and prognosis of AF7. Moreover, it is also one of the potential modifiable AF risk factors8 and HT management in people with AF is crucial to reduce the risk of long-term sequelae (e.g., stroke) and mortality.
The first recommended treatment for HT is lifestyle modification (e.g., physical activity, weight loss, healthy diets that include low sodium intake, and reduced alcohol consumption). Lifestyle programmes are also recommended as part of the holistic or integrated care management of AF9 apart from stroke prevention (with anticoagulation) and control of the heart rate or rhythm per se. Rhythm control is performed by cardioversion to normal sinus rhythm, or by electrophysiological procedures such as ablation; however, recurrence rates are relatively high after cardioversion (40-50% at 1 year) and ablation (25-30% at 1 year), mostly occurring in the first 2-3 months after the intervention1.
Whilst drug therapies can mitigate the recurrence of AF after rhythm control, lifestyle changes are also recommended in such patients. Nonetheless, lifestyle changes can be difficult to achieve and sustain, which results in a lack of adherence to management protocols 10. Hence, it is important to explore alternative pathways that are effective, easy to adopt, and sustainable. Whereas there are no official recommendations, mind-body interventions (e.g., yoga, meditation, mindfulness) have been proposed as potential intervention pathways and some evidence shows that they may improve AF symptoms and as well mental health outcomes11.
Music listening (ML) is a type of mind-body intervention that may offer a complementary, holistic pathway for HT and AF management. Evidence shows that sedative music can reduce both systolic (SBP) and diastolic (DBP) blood pressure13,14, heart (HR) respiration (RR) rates15, and increase Heart Rate Variability (HRV)15,16. Moreover, ML also has well-demonstrated anxiolytic, analgesic, and anti-depressant effects17 and is a well-established standalone and complementary intervention in a variety of clinical and non-clinical interventions for people of all ages. Nonetheless, very little research has been done in this area and the potential value of ML to self-manage HT and AF, albeit promising, is unknown.
In this Ph.D. project, you will design and evaluate new music-based lifestyle interventions that have the potential to empower people living with AF to have an active role in their health management and help them live better. The project will involve the exploration of the mechanistic underpinnings the potential benefits of music listening for heart health, the co-production of personalised ML interventions with people with lived experience of heart conditions, and a pilot evaluation of these interventions’ acceptability and effectiveness. The overarching aim is to determine whether personalised ML interventions are a viable pathway for AF patients to reduce the recurrence of AF episodes, manage their hypertension, and improve their mental health and quality of life.
References
1. Brundel BJJM, Ai X, Hills MT, Kuipers MF, Lip GYH, de Groot NMS. Atrial fibrillation. Nat Rev Dis Prim. 2022;8(1):21. doi:10.1038/s41572-022-00347-9
2. Ai Y, Xing Y, Yan L, et al. Atrial Fibrillation and Depression: A Bibliometric Analysis From 2001 to 2021. Front Cardiovasc Med. 2022;9:775329. doi:10.3389/fcvm.2022.775329
3. Berg SK, Thorup CB, Borregaard B, et al. Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: Findings from the national DenHeart survey. Eur J Prev Cardiol. 2019;26(6):624-637. doi:10.1177/2047487318769766
4. Burdett P, Lip GYH. Atrial fibrillation in the UK: Predicting costs of an emerging epidemic recognizing and forecasting the cost drivers of atrial fibrillation-related costs. Eur Hear J - Qual Care Clin Outcomes. 2022;8(2):187-194. doi:10.1093/ehjqcco/qcaa093
5. Adderley NJ, Ryan R, Nirantharakumar K, Marshall T. Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016. Heart. 2019;105(1):27-33. doi:10.1136/heartjnl-2018-312977
6. Palatinus JA, Das S. Your Father and Grandfather’s Atrial Fibrillation: A Review of the Genetics of the Most Common Pathologic Cardiac Dysrhythmia. Curr Genomics. 2015;16(2):75-81. doi:10.2174/1389202916666150108222031
7. Dzeshka MS, Shantsila A, Shantsila E, Lip GYH. Atrial Fibrillation and Hypertension. Hypertension. 2017;70(5):854-861. doi:10.1161/HYPERTENSIONAHA.117.08934
8. Elliott AD, Middeldorp ME, Van Gelder IC, Albert CM, Sanders P. Epidemiology and modifiable risk factors for atrial fibrillation. Nat Rev Cardiol. 2023;20(6):404-417. doi:10.1038/s41569-022-00820-8
9. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. August 2020. doi:10.1093/eurheartj/ehaa612
10. Carey RM, Moran AE, Whelton PK. Treatment of Hypertension: A Review. Jama. 2022;328(18):1849-1861. doi:10.1001/jama.2022.19590
11. Chung MK, Eckhardt LL, Chen LY, et al. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation. 2020;141(16):E750-E772. doi:10.1161/CIR.0000000000000748
12. Wahlström M, Rosenqvist M, Medin J, Walfridsson U, Rydell-Karlsson M. MediYoga as a part of a self-management programme among patients with paroxysmal atrial fibrillation – a randomised study. Eur J Cardiovasc Nurs. 2020;19(1):74-82. doi:10.1177/1474515119871796
13. Kühlmann AYR, Etnel JRG, Roos-Hesselink JW, Jeekel J, Bogers AJJC, Takkenberg JJM. Systematic review and meta-analysis of music interventions in hypertension treatment: A quest for answers. BMC Cardiovasc Disord. 2016;16(1):69. doi:10.1186/s12872-016-0244-0
14. Do Amaral MAS, Neto MG, De Queiroz JG, Martins-Filho PRS, Saquetto MB, Carvalho VO. Effect of music therapy on blood pressure of individuals with hypertension: A systematic review and Meta-analysis. Int J Cardiol. 2016;214:461-464. doi:10.1016/j.ijcard.2016.03.197
15. Kulinski J, Ofori EK, Visotcky A, Smith A, Sparapani R, Fleg JL. Effects of music on the cardiovascular system. Trends Cardiovasc Med. 2022;32(6):390-398. doi:10.1016/j.tcm.2021.06.004
16. Mojtabavi H, Saghazadeh A, Valenti VE, Rezaei N. Can music influence cardiac autonomic system? A systematic review and narrative synthesis to evaluate its impact on heart rate variability. Complement Ther Clin Pract. 2020;39:101162. doi:10.1016/j.ctcp.2020.101162
17. 17. Ellis RJ, Thayer JF. Music and autonomic nervous system (dys)function. Music Percept. 2010;27(4):317-326. doi:10.1525/mp.2010.27.4.317
2. Ai Y, Xing Y, Yan L, et al. Atrial Fibrillation and Depression: A Bibliometric Analysis From 2001 to 2021. Front Cardiovasc Med. 2022;9:775329. doi:10.3389/fcvm.2022.775329
3. Berg SK, Thorup CB, Borregaard B, et al. Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: Findings from the national DenHeart survey. Eur J Prev Cardiol. 2019;26(6):624-637. doi:10.1177/2047487318769766
4. Burdett P, Lip GYH. Atrial fibrillation in the UK: Predicting costs of an emerging epidemic recognizing and forecasting the cost drivers of atrial fibrillation-related costs. Eur Hear J - Qual Care Clin Outcomes. 2022;8(2):187-194. doi:10.1093/ehjqcco/qcaa093
5. Adderley NJ, Ryan R, Nirantharakumar K, Marshall T. Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016. Heart. 2019;105(1):27-33. doi:10.1136/heartjnl-2018-312977
6. Palatinus JA, Das S. Your Father and Grandfather’s Atrial Fibrillation: A Review of the Genetics of the Most Common Pathologic Cardiac Dysrhythmia. Curr Genomics. 2015;16(2):75-81. doi:10.2174/1389202916666150108222031
7. Dzeshka MS, Shantsila A, Shantsila E, Lip GYH. Atrial Fibrillation and Hypertension. Hypertension. 2017;70(5):854-861. doi:10.1161/HYPERTENSIONAHA.117.08934
8. Elliott AD, Middeldorp ME, Van Gelder IC, Albert CM, Sanders P. Epidemiology and modifiable risk factors for atrial fibrillation. Nat Rev Cardiol. 2023;20(6):404-417. doi:10.1038/s41569-022-00820-8
9. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. August 2020. doi:10.1093/eurheartj/ehaa612
10. Carey RM, Moran AE, Whelton PK. Treatment of Hypertension: A Review. Jama. 2022;328(18):1849-1861. doi:10.1001/jama.2022.19590
11. Chung MK, Eckhardt LL, Chen LY, et al. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation. 2020;141(16):E750-E772. doi:10.1161/CIR.0000000000000748
12. Wahlström M, Rosenqvist M, Medin J, Walfridsson U, Rydell-Karlsson M. MediYoga as a part of a self-management programme among patients with paroxysmal atrial fibrillation – a randomised study. Eur J Cardiovasc Nurs. 2020;19(1):74-82. doi:10.1177/1474515119871796
13. Kühlmann AYR, Etnel JRG, Roos-Hesselink JW, Jeekel J, Bogers AJJC, Takkenberg JJM. Systematic review and meta-analysis of music interventions in hypertension treatment: A quest for answers. BMC Cardiovasc Disord. 2016;16(1):69. doi:10.1186/s12872-016-0244-0
14. Do Amaral MAS, Neto MG, De Queiroz JG, Martins-Filho PRS, Saquetto MB, Carvalho VO. Effect of music therapy on blood pressure of individuals with hypertension: A systematic review and Meta-analysis. Int J Cardiol. 2016;214:461-464. doi:10.1016/j.ijcard.2016.03.197
15. Kulinski J, Ofori EK, Visotcky A, Smith A, Sparapani R, Fleg JL. Effects of music on the cardiovascular system. Trends Cardiovasc Med. 2022;32(6):390-398. doi:10.1016/j.tcm.2021.06.004
16. Mojtabavi H, Saghazadeh A, Valenti VE, Rezaei N. Can music influence cardiac autonomic system? A systematic review and narrative synthesis to evaluate its impact on heart rate variability. Complement Ther Clin Pract. 2020;39:101162. doi:10.1016/j.ctcp.2020.101162
17. 17. Ellis RJ, Thayer JF. Music and autonomic nervous system (dys)function. Music Percept. 2010;27(4):317-326. doi:10.1525/mp.2010.27.4.317
Project supervisors
Career overview
Dr Eduardo Coutinho is a Senior Lecturer in Music Psychology at the University of Liverpool, where he leads the Applied Music Research Lab (AM Lab). His research is dedicated to exploring how music can be applied in everyday life to enhance people''s lives, with a particular focus on developing methods and tools that allow individuals to benefit from music engagement in everyday contexts, especially its therapeutic potential. Dr Coutinho''s interests encompass music and emotion, music and health, music cognition, and the innovative use of music computing and technology. Prior to his position at Liverpool, Dr Coutinho worked at several institutions, including Imperial College London, University of Augsburg, Technical University of Munich, Swiss Centre for Affective Science, and University of Sheffield. He obtained his PhD from the University of Plymouth and his undergraduate degree from the University of Porto.
Research interests
Dr Coutinho''s research focuses on the application of music in everyday life to enhance well-being, with a particular emphasis on its therapeutic potential. He is dedicated to developing methods and tools that maximise the benefits of music engagement in various contexts. His specific areas of interest include music and emotion, music and health, music cognition, and the innovative use of music computing and technology.
Career overview
Dr Alena Shantsila completed her undergraduate degree in Medicine (MD) with distinction at Grodno State Medical University in Belarus. She practised medicine until 2008, when she joined the University Department of Medicine at City Hospital in Birmingham, supported by the Lancet International Fellowship. During this time, Dr Shantsila explored endothelial damage in patients with malignant hypertension, with the results published in a high-impact journal. She later contributed to several research projects in the department, focusing on recruitment, imaging, and data analyses for the Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES). Dr Shantsila was responsible for developing and validating the methodology for assessing carotid plaque neovascularisation through contrast ultrasonography. In January 2012, she began work on a British Heart Foundation-funded project at the School of Sport, Exercise & Rehabilitation Sciences at the University of Birmingham, investigating the role of respiratory modulation of muscle sympathetic nerve activity in hypertensive patients and the effects of long-term breathing interventions. This research formed the basis of her PhD, which she completed in 2016. Her study received recognition as ‘The highest ranked abstract in the Stable IHD/Prevention/Hypertension/Lipids category’ at the British Cardiovascular Society annual conference in 2015. From November 2014 to July 2019, Dr Shantsila held academic positions at the Institute of Cardiovascular Sciences at the University of Birmingham before joining the University of Liverpool as a Lecturer in Cardiovascular Health in July 2019.
Research interests
Dr Shantsila''s research focuses on cardiovascular health, particularly in the context of hypertension. She has explored endothelial damage in patients with malignant hypertension, with her findings published in a high-impact journal. Dr Shantsila has also been involved in the Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES), where she contributed to the development and validation of methodologies for assessing carotid plaque neovascularisation using contrast ultrasonography. Her PhD research, which examined the role of respiratory modulation of muscle sympathetic nerve activity in hypertensive patients and the effects of long-term breathing interventions, received recognition at the British Cardiovascular Society annual conference.
Cardiovascular Health
Endothelial Damage
Malignant Hypertension
Carotid Plaque Neovascularisation
Contrast Ultrasonography
Muscle Sympathetic Nerve Activity
Hypertension
Breathing Intervention
Ethnic-Echocardiographic Heart of England Screening Study
British Cardiovascular Society
Medical Education
Research Methodology
Data Analysis
Clinical Medicine
BHF-Funded Research
PhD in Cardiovascular Sciences.
Career overview
Professor Gregory Lip is the Price-Evans Chair of Cardiovascular Medicine at the University of Liverpool, UK, and serves as the Director of the Liverpool Centre for Cardiovascular Science at both the University of Liverpool and Liverpool Heart & Chest Hospital. He is also a Distinguished Professor at Aalborg University in Denmark and holds adjunct professorships at Seoul National University and Yonsei University in South Korea. Additionally, he has been awarded Visiting or Honorary Professorships at various universities across the UK, Serbia, China, Thailand, and Taiwan. Professor Lip dedicates half of his professional time to clinical cardiology, where he leads outpatient clinics focused on atrial fibrillation and hypertension specialist services, as well as acute cardiology. His research interests prominently include the epidemiology of atrial fibrillation (AF) and the pathophysiology of thromboembolism associated with this arrhythmia. He has extensively studied stroke and bleeding risk factors, contributing to the development of clinical risk stratification tools. Notably, the CHA2DS2-VASc and HAS-BLED scores, which assess stroke and bleeding risk respectively, were first proposed and validated through his research and are now integral to international guidelines. Professor Lip''s ABC (Atrial fibrillation Better Care) pathway is a key recommendation in the 2020 European AF guidelines and has demonstrated effectiveness in reducing adverse outcomes for AF patients. In 2014, he was recognised by Expertscape as the leading global expert in the understanding and treatment of AF, a title he has maintained into 2023. He has played a significant role in the formulation of various international guidelines, chairing the American College of Chest Physicians (ACCP) Antithrombotic Therapy Guidelines for Atrial Fibrillation, and contributing to guidelines from the European Society of Cardiology (ESC), European Heart Rhythm Association (EHRA), and Asia-Pacific Heart Rhythm Society (APHRS). In addition to his editorial roles, Professor Lip has served as senior/section editor for major international textbooks and journals, including Thrombosis & Haemostasis (Editor-in-Chief, Clinical Studies), Europace (Associate Editor), and Circulation (Guest Editor). His current research group focuses on a wide range of topics, including epidemiology, pathophysiology, translational research, clinical risk assessment, patient management pathways, and applied health research. He is particularly passionate about leveraging ''big data'' and epidemiological insights to inform clinical studies aimed at improving the management of prevalent cardiovascular conditions such as atrial fibrillation, hypertension, and thrombosis. This research often involves collaboration with a global network of colleagues across Denmark, France, the Balkans, Taiwan, Korea, and Japan, reflecting a commitment to ''research without boundaries'' in epidemiology and clinical studies. Professor Lip has received several honorary doctorate degrees, including doctor medicinae honoris causa from Aalborg University, University of Medicine & Pharmacy “Carol Davila” in Bucharest, Belgrade University, and Université de Tours in France. In 2020, he was awarded honorary doctorates from the Medical University of Silesia in Katowice, Poland, and the University of Modena in Italy.
Research interests
Professor Lip''s research primarily focuses on the epidemiology of atrial fibrillation (AF) and the pathophysiology of thromboembolism associated with this arrhythmia. He has investigated stroke and bleeding risk factors, as well as advancements in clinical risk stratification. His contributions include the development and validation of the CHA2DS2-VASc and HAS-BLED scores for assessing stroke and bleeding risk, which are now integral to international guidelines. Additionally, he proposed the ABC (Atrial fibrillation Better Care) pathway, which is a key recommendation in the 2020 European AF guidelines and has demonstrated efficacy in reducing adverse outcomes for AF patients. Professor Lip has been recognised as a leading expert in AF, maintaining a top ranking by Expertscape since 2014. He has played a significant role in the formulation of various international guidelines, including chairing the American College of Chest Physicians (ACCP) Antithrombotic Therapy Guidelines for Atrial Fibrillation and contributing to guidelines from the European Society of Cardiology (ESC) and the European Heart Rhythm Association (EHRA). His current research group explores a wide range of topics, including epidemiology, pathophysiology, translational research, clinical risk assessment, patient management pathways, and applied health research. Professor Lip is particularly passionate about leveraging ''big data'' and epidemiological observations to generate hypotheses and inform clinical studies aimed at improving the management of prevalent cardiovascular conditions such as atrial fibrillation, hypertension, and thrombosis. This research often involves collaboration with a global network of colleagues across various countries, promoting a vision of ''research without boundaries'' in the fields of epidemiology and clinical studies.
Cardiovascular Medicine
Atrial Fibrillation
Hypertension
Thromboembolism
Epidemiology
Stroke Risk
Bleeding Risk
Clinical Risk Stratification
CHA2DS2-VASc Score
HAS-BLED Score
ABC Pathway
Translational Research
Patient Management Pathways
Big Data
Health Research
International Guidelines
Clinical Studies
Cardiovascular Conditions
Research Collaboration
Global Network
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