Dr David Gaze has spent two decades pioneering the use of non-invasive tests for heart muscle damage, improving patient care and saving the NHS money.
There are currently 7.4 million people living with cardiac conditions in the UK, resulting in approximately 170,000 deaths per year.
Dr Gaze has spent two decades pioneering the clinical use of cardiac troponins – proteins that can diagnose heart disease in clinical settings.
Blood testing of this kind is a safer, quicker and cheaper alternative to invasive surgical procedures, which have traditionally been used.
Since joining the University of Westminster in 2016, Dr Gaze’s research has helped to expand the uses of this form of testing and to increase its adoption, to the benefit of patients, healthcare services, and industry.
Troponin and COVID-19
While Troponin proteins had previously only been used to identify heart disease, Dr Gaze and his colleagues expanded its use to other chronic diseases, including end-stage renal disease, high blood pressure, and chronic kidney disease.
Early in the first wave of the pandemic, Gaze reviewed COVID-19 data from the five major outbreak regions and found that although cardiac troponin is elevated in the most severe cases of the illness, most patients’ levels were stable.
This first-of-its-kind research has enabled clinicians to use troponin tests to establish whether COVID-19 is the cause of a specific heart condition called myocarditis.
Shaping public health guidelines in the UK and US
The Association for Clinical Biochemistry & Laboratory Medicine (ACB) is the professional body for all NHS clinical laboratory workers.
Dr Gaze is a member of the expert panel on cardiac biomarkers within the Scientific Committee of the ACB, whose Scientific Director highlights Dr Gaze’s “unrivalled insight into the developing and current research around the key cardiac marker Troponin”.
For this reason, Gaze regularly provides advice on key guidance around cardiac troponins on behalf of the ACB.
When the Academy of Medical Royal Colleges (AMRC) sought feedback on their Evidence-Based Interventions document, Dr Gaze wrote the ACB’s detailed written response on the troponin tests.
He suggested improvements and argued against “coding and restriction of use of high sensitivity cardiac troponin”, which “will have a negative effect on patient experience and outcomes”.
The AMRC followed these suggestions in its November 2020 guidance – which relies heavily on the 2020 NICE guidance that Dr Gaze also advised on, as a representative of the ACB.
The benefits of ensuring access to, and usage of, such troponin tests are that they reduce invasive, risky, procedures on patients, and create cost-savings for the NHS due to the reduced time a patient needs to spend in a hospital.
A 2019 study found the tests saved one NHS Trust approximately £788,000 by reducing unnecessary admissions, while an Australian study found that reduced length of stay from the use of such tests saves the NHS over 9 million AUD per year.
As a member of the Scientific Practice Core Committee (SPCC) of the American Association of Clinical Chemistry (AACC), Dr Gaze has also had a significant impact on public health guidelines in the United States.
The widely used CK-MB (creatine kinase myocardial band) test was once considered the “gold standard” test for heart attacks – but Gaze’s research has found that troponin tests have greater sensitivity and a wider scope of application.
In his work for the AACC, who are advisors to the U.S. Department of Health and Human Services, Dr Gaze was pivotal in having the CK-MB test replaced with the troponin test for heart attacks in official U.S. health guidance.
As the founding Chair of SPCC states: “The impact on clinical practice for this recommendation is the reduction of un-necessary testing, drawing of less blood as well as financial savings”.
Providing expert advice to a range of stakeholders
Along with national guidelines, in his role as an expert panellist at the ACB, Dr Gaze also provides advice on a wide range of requests from clinicians, diagnostic companies, media, and other stakeholders.
Dr Gaze is an expert in this field and his laboratory provides clinical services, underpinned by his research knowledge, to many clinical laboratories across the UK and beyond.
– The Scientific Director of the Association for Clinical Biochemistry & Laboratory Medicine
On one occasion, Dr Gaze was able to confirm a patient’s raised cardiac Troponin-I was due to a rare condition called macroTroponin, rather than heart disease.
“This finding allowed the patient pathway to be refined so they did not have to undergo a prolonged hospital stay and excessive further investigations,” the ACB’s Scientific Director explains.
On another occasion, Dr Gaze used his knowledge of troponins to help settle a Crown Court case.
Following a physical fight, the defendant was taken to hospital with chest pain and raised troponin levels which led doctors to suspect a heart attack.
As an expert witness on behalf of the ACB, Dr Gaze explained the blunt chest trauma from a punch could both temporarily raise troponin levels and also cause the chest pain suffered by the defendant.
As a result, the defence was able to successfully argue that the other party hit their client in the chest first and that he was acting in self-defence.
Impact on industry professionals
Expand Healthcare Consulting has enlisted Dr Gaze to provide expert advice on improving troponin tests. According to its Managing Partner, the collaboration works because Gaze is a “fiercely neutral academic”.
He possesses the rare skill to communicate effectively and act as a bridge between healthcare and industry.
- The Managing Partner of Expand Healthcare Consulting
Gaze’s engagement with this consultancy company has focussed on point-of-care (POC) products, which can produce quicker results by being undertaken on-site, rather than having the blood sample sent to a remote laboratory.
Gaze has worked with the company “to develop pragmatic testing protocols with the capability to test a pre-market system with real clinical samples”.
This improvement of the research and development pipeline saves time and money by enabling the company’s clients to see whether or not their product is viable or effective, “early enough to make adjustment”.
Dr Gaze’s research, the Managing Partner adds, has had an “immense” impact that “if calculated would run into 100s of thousands of saved lives and improved patient outcomes”.
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