4-year PhD Studentship: Does this dog need drugs? Clinical decision making for cardiac patients managed in primary care veterinary practice.

Myxomatous mitral valve disease (MMVD) is the most common acquired heart disease in dogs, accounting for ~80% of canine cardiac disease.1,2 MMVD primarily affects small- and medium-sized breeds, with some breeds such as the Cavalier King Charles Spaniel being markedly overrepresented.3 The majority of cases present to primary-care practice, where they are typically managed throughout the course of the disease. The American College of Veterinary Internal Medicine (ACVIM) have produced guidelines for diagnosis, staging and management of the disease.4 The guidelines report on the level and quality of available evidence which predominantly is based upon studies conducted in tertiary care cohorts. Recommendations are based on consensus of opinion among a panel of 10 specialist cardiologists and therefore represent a “top down” approach, which risks the guidelines not being easily applied to a primary-care setting. Characterisation of how patients are being managed in primary-care practice would allow the extent to which these guidelines are followed to be explored. This can be achieved using and combination of electronic healthcare records (EHR), which facilitate large scale data capture across a wide range of primary-care practices and patient circumstances, and structured interviews with primary-care veterinarians.

Aims and Objectives

Aims

1. Using data from EHR: a. Define the population characteristics of dogs likely to have MMVD (which did not receive cardiac medications prior to 1st January 2019); b. Identify factors associated with initiation of treatment with cardiac medications
2. To explore factors and themes identified in EHR analysis in more depth through semi-structured interviews with primary-care veterinarians and dog owners.

Objective

1. To investigate whether initiation of treatment in primary-care practice is driven more by a patient’s history, physical examination features and owner-related factors and less by the results of diagnostic tests as recommended in the ACVIM guidelines.

Methodology

VetCompass (https://www.rvc.ac.uk/vetcompass) collects anonymised electronic clinical data from >30% of all UK veterinary practices. We will use these stored data to investigate how primary-care veterinarians manage MMVD, including information about the animals, their presenting signs, examination findings, diagnostic tests performed and medications prescribed. We will collect data obtained in one calendar year from dogs likely to be affected by MMVD (small- and medium-sized dogs ≥5 years old) that had not previously received cardiac medications. Dogs will be divided into 3 groups (group x; no cardiac medications received, group y; diuretics initiated (required for treatment of congestive heart failure) and group z; other cardiac medications initiated (as expected in advanced preclinical disease)). Analysis of these data will identify factors associated with animals being started on a. diuretics and b. other cardiac medications.

These factors and associated clinical themes will be further explored through semi-structured interviews with primary-care veterinarians and owners of dogs with MMVD across a range of demographic groups. This will provide invaluable information about how this common disease is managed in primary-care practice. MMVD guidelines will then be developed with primary-care veterinarians, allowing a higher proportion of affected dogs to benefit from optimal care, improving their health and welfare.

Keywords

Veterinary cardiology, myxomatous mitral valve disease

How to apply for this project

This project will be based in Bristol Veterinary School in the Faculty of Health Sciences at the University of Bristol.

Please visit the Faculty of Health Sciences website for details of how to apply