John J V McMurray

Uppsala University, Uppsala, Uppsala, Sweden

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Publications (513)5800.95 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Increases in serum creatinine with renin-angiotensin-aldosterone system (RAAS) inhibitors can lead to unnecessary discontinuation of these agents. The dual-acting angiotensin receptor neprilysin inhibitor LCZ696 improves clinical outcome patients with heart failure with reduced ejection fraction, and pilot data suggest potential benefit in heart failure with preserved ejection fraction (HFpEF). The effects of LCZ696 on renal function have not been assessed. A total of 301 HFpEF patients were randomly assigned to LCZ696 or valsartan in the PARAMOUNT trial. We studied renal function [creatinine, estimated glomerular filtration rate (eGFR), cystatin C, and urinary albumin to creatinine ratio (UACR)] at baseline, 12 weeks, and after 36 weeks of treatment. Worsening renal function (WRF) was determined as an serum creatinine increase of >0.3 mg/dL and/or >25% between two time-points. Mean eGFR at baseline was 65.4 ± 20.4 mL/min per 1.73 m(2) . The eGFR declined less in the LCZ696 group than in the valsartan group (-1.5 vs. -5.2 mL/min per 1.73 m(2) ; P = 0.002). The incidence of WRF was lower in the LCZ696 group (12%) than in the valsartan group (18%) at any time-point, but this difference was not statistically significant (P = 0.18). Over 36 weeks, the geometric mean of UACR increased in the LCZ696 group (2.4-2.9 mg/mmol), whereas it remained stable in the valsartan group (2.1-2.0 mg/mmol; P for difference between groups = 0.016). In patients with HFpEF, therapy with LCZ696 for 36 weeks was associated with preservation of eGFR compared with valsartan therapy, but an increase in UACR. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.
    European Journal of Heart Failure 02/2015; · 6.58 Impact Factor
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    ABSTRACT: There are more than 1 million primary hospitalizations for heart failure (HF) annually in the USA alone, and post-discharge outcomes remain persistently poor despite available therapies and quality improvement initiatives. Recent international randomized clinical trials in hospitalized HF have repeatedly failed to improve this post-discharge event rate. A potential reason for this persistent lack of clinical trial success that has not previously received significant attention relates to site selection and the generally low level of patient enrollment from the USA. Only ~5 % of US hospitals participate in clinical trials, and in four recent randomized trials of hospitalized HF, only one-third of patients were enrolled in North America. This poor participation among US centers has necessitated disproportionate enrollment from non-US sites. Regional variations in HF patient characteristics and clinical outcomes are well documented, and a lack of US patient representation in clinical trials limits the generalizability of results and presents obstacles for US regulatory agency approval. There are multiple impediments to successful US enrollment including a lack of incentive for investigators and institutions, the relative value unit-based compensation system, poor institutional framework for identification of appropriate patients, and increasing liability to conduct trials. In this manuscript, we specifically identify barriers to successful hospitalized HF clinical trial participation in the USA and suggest possible solutions.
    Heart Failure Reviews 02/2015; · 3.99 Impact Factor
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    ABSTRACT: Leucocyte telomere length is considered a marker of biological ageing and has been suggested to be shorter in patients with CAD and heart failure compared with healthy controls. The aim of this study was to determine whether telomere length is associated with clinical outcomes in patients with ischaemic heart failure and whether this association is superior to chronological age as defined by date of birth. We measured leucocyte telomere length in 3275 patients with chronic ischaemic systolic heart failure participating in the COntrolled ROsuvastatin multiNAtional Trial in Heart Failure (CORONA) study. The primary composite endpoint was cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke, which occurred in 575 patients during follow-up. We observed a significant association of leucocyte telomere lengths with the primary endpoint (hazard ratio 1.10; 95% confidence interval 1.01-1.20; P = 0.03). However, this observation was not superior to age as defined by date of birth. The neutral effect of rosuvastatin treatment on clinical outcomes was not modified by baseline telomere length. Biological age as defined by leucocyte telomere length was associated with clinical outcomes in patients with ischaemic heart failure, but this association did not add prognostic information above age as defined by date of birth. © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.
    European journal of heart failure. 02/2015;
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    ABSTRACT: AimsTo investigate the relationship between angina pectoris and fatal and non-fatal clinical outcomes in heart failure with reduced and preserved ejection fraction (HF-REF and HF-PEF, respectively).Methods and resultsOf 7599 patients in the CHARM program, 5408 had ischaemic heart disease; 3855 had HF-REF (ejection fraction ≤45%) and 1553 had HF-PEF. These patients were separated into three groups: no history of angina, previous angina, and current angina. Three coronary outcomes were examined: fatal or non-fatal myocardial infarction (MI); MI or hospitalization for unstable angina (UA); and MI, UA or coronary revascularization. The composite heart failure outcome of cardiovascular death or heart failure hospitalization (HFH) was also analysed, along with its components and all-cause mortality. New York Heart Association functional class was worse in both HF-REF and HF-PEF patients with current angina compared with patients without angina (P < 0.001 and P = 0.005 respectively), despite similar clinical examination findings and ejection fraction. Patients with current angina had a higher risk of all three coronary outcomes (adjusted hazard ratios ranging from 1.8–3.1) than those without angina but did not have a higher risk of heart failure outcomes or all-cause mortality.Conclusion In patients with heart failure current angina is associated with significantly more functional limitation and a higher risk of coronary events, across the spectrum of left ventricular ejection fraction.
    European Journal of Heart Failure 02/2015; 17(2). · 6.58 Impact Factor
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    ABSTRACT: Low pulse pressure is a marker of adverse outcome in patients with heart failure (HF) and reduced ejection fraction (HF-REF) but the prognostic value of pulse pressure in patients with HF and preserved ejection fraction (HF-PEF) is unknown. We examined the prognostic value of pulse pressure in patients with HF-PEF [ejection fraction (EF) ≥ 50%] and HF-REF. Data from 22 HF studies were examined. Preserved left ventricular ejection fraction (LVEF) was defined as LVEF ≥ 50%. All-cause mortality at 3 years was evaluated in 27 046 patients: 22 038 with HF-REF (4980 deaths) and 5008 with HF-PEF (828 deaths). Pulse pressure was analysed in quintiles in a multivariable model adjusted for the previously reported Meta-Analysis Global Group in Chronic Heart Failure prognostic variables. Heart failure and reduced ejection fraction patients in the lowest pulse pressure quintile had the highest crude and adjusted mortality risk (adjusted hazard ratio 1.68, 95% confidence interval 1.53-1.84) compared with all other pulse pressure groups. For patients with HF-PEF, higher pulse pressure was associated with the highest crude mortality, a gradient that was eliminated after adjustment for other prognostic variables. Lower pulse pressure (especially <53 mmHg) was an independent predictor of mortality in patients with HF-REF, particularly in those with an LVEF < 30% and systolic blood pressure <140 mmHg. Overall, this relationship between pulse pressure and outcome was not consistently observed among patients with HF-PEF. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    European heart journal. 01/2015;
  • John J V McMurray, Dirk J van Veldhuisen
    The Lancet 01/2015; 384(9961). · 39.21 Impact Factor
  • Ross T. Campbell, Andrew R. McKean, John J.V. McMurray
    European Journal of Heart Failure 12/2014; 16(12). · 6.58 Impact Factor
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    ABSTRACT: Although cardiac troponin is associated with outcomes in atrial fibrillation (AF), the complementary prognostic information provided by cardiac troponin I (cTnI) and cTnT is unknown. This study investigated the distribution, determinants, and prognostic value of cTnI and cTnT concentrations in patients with AF. At the time of randomization, we analyzed cTnI and cTnT concentrations of 14 806 AF patients in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial using high-sensitivity assays. Correlations (Spearman), determinants (multiple analysis of variance), and outcomes (adjusted Cox models and c-statistics) were investigated. Concentrations of cTnI and cTnT were correlated (r = 0.70) and measurable in most participants [cTnI 98.5% (median 5.4 ng/L, ≥99th percentile in 9.2%) and cTnT 93.5% (median 10.9 ng/L, ≥99th percentile in 34.4%)]. Renal impairment was the most important factor affecting the concentrations of both troponins. cTnI increase was more associated with heart failure, vascular disease, and persistent/permanent AF, and cTnT with age, male sex, and diabetes. Over a median 1.9 years of follow-up, patients with both troponins above the median had significantly higher risk for stroke/systemic embolism [hazard ratio (HR) 1.72 (95% CI 1.31-2.27)], cardiac death [3.14 (2.35-4.20)], and myocardial infarction [2.99 (1.78-5.03)] than those with both troponins below median (all P < 0.005). Intermediate risks were observed when only 1 troponin was above the median. When combined with clinical information, each marker provided similar prognostication and had comparable c-statistics. cTnI and cTnT concentrations are moderately correlated and measurable in plasma of most AF patients. The risk of stroke and cardiovascular events is highest when both troponins are above median concentrations. Each troponin provides comparable prognostic information when combined with clinical risk factors. © 2014 American Association for Clinical Chemistry.
    Clinical Chemistry 12/2014; · 7.77 Impact Factor
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    ABSTRACT: AimsTo investigate the prognostic significance of hospitalization for worsening heart failure (WHF), myocardial infarction (MI), and stroke in patients with chronic heart failure (HF).Methods and resultsWe studied 5011 patients with HF and reduced EF (HF-REF) in the CORONA trial and 4128 patients with HF and preserved EF (HF-PEF) in the I-Preserve trial. Adjusted hazard ratios (HRs) for death were estimated for 0–30 days and ≥31 days after first post-randomization WHF, MI, or stroke used as a time-dependent variable, compared with patients with none of these events. In CORONA, 1616 patients (32%) had post-randomization first events (1223 WHF, 216 MI, 177 stroke), and the adjusted HR for mortality ≤30 days after an event was: WHF 7.21 [95% confidence interval (CI) 2.05–25.40], MI 23.08 (95% CI 6.44–82.71), and stroke 32.15 (95% CI 8.93–115.83). The HR for mortality at >30 days was: WHF 3.62 (95% CI 3.11–4.21), MI 4.41 (95% CI 3.23–6.02), and stroke 3.19 (95% CI 2.21–4.61). In I-Preserve, 896 patients (22%) experienced a post-randomization event (638 WHF, 111 MI, 147 stroke). The HR for mortality ≤30 days was WHF 31.77 (95% CI 7.60–132.81), MI 154.77 (95% CI 34.21–700.17), and stroke 223.30 (95% CI 51.42–969.78); for >30 days it was WHF 3.36 (95% CI 2.79–4.05), MI 3.29 (95% CI 2.14–5.06), and stroke 5.13 (95% CI 3.61–7.29).Conclusions In patients with both HF-REF and HF-PEF, hospitalization for WHF was associated with high early and late mortality. The early relative risk of death was not as great as following MI or stroke, but the longer term relative risk of death was similar following all three types of event. Numerically, more deaths occurred following WHF because it was a much more common event.
    European Journal of Heart Failure 12/2014; · 6.58 Impact Factor
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    ABSTRACT: Objectives: Increased circulating endostatin levels have been demonstrated in progressive cardiovascular (CV) and renal disorders. We investigated the predictive value of endostatin in patients with chronic heart failure (HF) and the association between endostatin and renal function. Methods: The interaction between serum endostatin, estimated glomerular filtration rate (eGFR) and predefined endpoints, including the primary endpoint (CV death, nonfatal myocardial infarction, nonfatal stroke; n = 397), all-cause mortality (n = 410), CV death (n = 335) or the coronary endpoint (n = 317), was evaluated in 1,390 patients >60 years of age with ischemic systolic HF in the Controlled Rosuvastatin Multinational Trial in HF (CORONA) population, who were randomly assigned to 10 mg rosuvastatin or placebo. Results: In the population as a whole, endostatin added no predictive information after full multivariable adjustment including eGFR and N-terminal pro-brain natriuretic peptide. Serum endostatin was strongly correlated with eGFR (r = 0.59, p < 0.001). After full multivariable adjustment, an association between high serum endostatin and increased risk of all-cause mortality and decreased risk of the primary and coronary endpoints was seen in HF patients with impaired and preserved renal function, respectively. Conclusions: Endostatin added no predictive information regarding the adverse outcome in patients with chronic systolic HF of ischemic etiology. An increased risk of all-cause mortality was seen in patients with decreased renal function. © 2014 S. Karger AG, Basel.
    Cardiology 11/2014; 130(1):17-22. · 2.04 Impact Factor
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    ABSTRACT: Contemporary studies suggest an association between venous thromboembolism and a higher incidence of major cardiovascular events, mostly attributed to arterial atherothrombosis. Using data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial, we assessed the association of venous thromboembolism with major cardiovascular events.Methods In NAVIGATOR, patients with impaired glucose tolerance were randomly allocated to receive valsartan or placebo and nateglinide or placebo in addition to lifestyle modification. Baseline characteristics and prior history of venous thromboembolism were assessed. After adjusting for important baseline covariates, Cox proportional hazards regression models were used to assess the association between venous thromboembolism and major cardiovascular outcomes.ResultsOf the 9306 patients enrolled, 129 (1.4%) had a history of venous thromboembolism. Patients with venous thromboembolism were older, more frequently white and female, and had a higher body mass index. Patients with venous thromboembolism had higher 5-year event rates for the composite of death, myocardial infarction, and stroke as compared with patients without venous thromboembolism (10.7% vs. 5.9%; P<0.001; adjusted hazard ratio [HR] 2.12, 95% confidence interval [CI] 1.36–3.31; P=0.001).Conclusion In patients with impaired glucose tolerance at high risk for cardiovascular events, the prevalence of venous thromboembolism was rare but associated with worse long-term cardiovascular outcomes, including arterial events. Venous thromboembolism is a marker of risk, and attention should be paid to this high-risk group of patients.Clinical trial registrationClinicalTrials.gov: NCT00097786.
    The American Journal of Medicine 11/2014; · 5.30 Impact Factor
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    ABSTRACT: -International geographic differences in outcomes may exist for clinical trials of heart failure and reduced ejection fraction (HF-REF), but there are few data for those with preserved ejection fraction (HF-PEF). -We analyzed outcomes by international geographic region in the Irbesartan in Heart Failure with Preserved systolic function trial (I-Preserve), the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved trial, the CHARM-Alternative and CHARM-Added HF-REF trials, and the Controlled Rosuvastatin Multinational Trial in HF-REF (CORONA). Crude rates of heart failure hospitalization varied by geographic region, and more so for HF-PEF than for HF-REF. Rates in patients with HF-PEF were highest in the United States/Canada (HF hospitalization rate 7.6 per 100 patient-years in I-Preserve; 8.8 in CHARM-Preserved), intermediate in Western Europe (4.8/100 and 4.7/100), and lowest in Eastern Europe/Russia (3.3/100 and 2.8/100). The difference between the United States/Canada versus Eastern Europe/Russia persisted after adjustment for key prognostic variables: adjusted hazard ratios 1.34 (95% confidence interval, 1.01-1.74; P=0.04) in I-Preserve and 1.85 (95% confidence interval, 1.17-2.91; P=0.01) in CHARM-Preserved. In HF-REF, rates of HF hospitalization were slightly lower in Western Europe compared with other regions. For both HF-REF and HF-PEF, there were few regional differences in rates of all-cause or cardiovascular mortality. -The differences in event rates observed suggest there is international geographic variation in 1 or more of the definition and diagnosis of HF-PEF, the risk profile of patients enrolled, and the threshold for hospitalization, which has implications for the conduct of future global trials.
    Circulation 11/2014; · 14.95 Impact Factor
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    ABSTRACT: -Clinical trials in heart failure have focused on the improvement in symptoms or decreases in the risk of death and other cardiovascular events. Little is known about the effect of drugs on the risk of clinical deterioration in surviving patients. -We compared the angiotensin-neprilysin inhibitor LCZ696 (400 mg daily) with the angiotensinconverting enzyme inhibitor enalapril (20 mg daily) in 8399 patients with heart failure and reduced ejection fraction in a double-blind trial. The analyses focused on prespecified measures of nonfatal clinical deterioration. In comparison with the enalapril group, fewer LCZ696-treated patients required intensification of medical treatment for heart failure (520 versus 604; hazard ratio, 0.84; 95% confidence interval, 0.74-0.94; P=0.003) or an emergency department visit for worsening heart failure (hazard ratio, 0.66; 95% confidence interval, 0.52-0.85; P=0.001). The patients in the LCZ696 group had 23% fewer hospitalizations for worsening heart failure (851 versus 1079; P<0.001) and were less likely to require intensive care (768 versus 879; 18% rate reduction, P=0.005), to receive intravenous positive inotropic agents (31% risk reduction, P<0.001), and to have implantation of a heart failure device or cardiac transplantation (22% risk reduction, P=0.07). The reduction in heart failure hospitalization with LCZ696 was evident within the first 30 days after randomization. Worsening of symptom scores in surviving patients was consistently more common in the enalapril group. LCZ696 led to an early and sustained reduction in biomarkers of myocardial wall stress and injury (N-terminal pro-Btype natriuretic peptide and troponin) versus enalapril. -Angiotensin-neprilysin inhibition prevents the clinical progression of surviving patients with heart failure more effectively than angiotensin-converting enzyme inhibition. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255.
    Circulation 11/2014; · 14.95 Impact Factor
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    ABSTRACT: The extracellular matrix (ECM) plays an important role in left ventricular remodeling and progression of heart failure (HF). Biglycan and mimecan are ECM proteins that are abundantly expressed in cardiac tissue but have not been evaluated as prognostic markers in HF. We investigated their interaction with statin treatment and association with adverse outcome in chronic HF. The association between serum levels of biglycan and mimecan and the primary endpoint (cardiovascular (CV) death, nonfatal myocardial infarction, nonfatal stroke), all-cause mortality, CV death, the composite of all-cause mortality/hospitalization for worsening of HF or the coronary endpoint was evaluated in 1390 patients >60 years of age with ischemic systolic HF in the Controlled Rosuvastatin Multinational Trial in HF (CORONA) population, randomly assigned to 10 mg rosuvastatin or placebo. Serum biglycan and mimecan added no prognostic information beyond conventional risk factors including NT-proBNP. However, statin treatment improved all outcomes except CV death in patients with low biglycan levels (i.e. lower tertile), even after full multivariable adjustment. Although circulating levels of mimecan and biglycan were of limited predictive value in patients with chronic HF, circulating biglycan could be a useful marker for targeting statin therapy in patients with HF. Copyright © 2014 Elsevier Inc. All rights reserved.
    Journal of Cardiac Failure 11/2014; · 3.07 Impact Factor
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    ABSTRACT: Given the rising prevalence of heart failure (HF), our objective is to explore the relationships between meteorological events and acute HF (AHF) globally. We used data from 30 countries participating in the ASCEND-HF trial. Parameters including temperature were normalized by location for the 37days prior to the HF event. Meteorological events were classified as a change that occurred <10% compared to baseline. The 7days prior to the HF event was subdivided: T1: the day of and -1day; T2: 2 and 3days; T3: 4 and 5days; and T4: 6 and 7days. Results are reported as ratios of observed to expected weather events at the time of AHF presentation. From 7141 patients, median age was 67 (IQR 56-76) with 66% male patients and 60% of patients with ischemic cardiomyopathy. In T1, temperatures were warmer than expected with 10% fewer decreases in average [OR 0.91 95% CI (0.83-0.98)] and minimum [OR 0.90 95% CI (0.82-0.97)] temperature. In T2, temperatures were again warmer than expected with an excess number of increases in maximum [OR 1.18 95% CI (1.06-1.30)] and average [OR 1.21 95% CI (1.10-1.32)] temperature. In T4 temperatures were cooler than baseline with fewer increases [OR 0.84 95% CI (0.74-0.95)] in average temperature. Meteorological fluctuations appear most relevant in the 3days (T1 and T2) prior to the HF hospitalization with temperature demonstrating a bidirectional relationship with AHF. Continued validation of biometeorological trends in HF will contribute to healthcare system planning globally. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 11/2014; 177(3):819-824. · 6.18 Impact Factor
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    ABSTRACT: Worsening heart failure (WHF) in the first 7 days after an admission for acute HF (AHF) has been proposed as a therapeutic target in several recent AHF studies and was a co-primary endpoint of the VERITAS studies.
    European Journal of Heart Failure 11/2014; · 6.58 Impact Factor
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    ABSTRACT: Little is known about global patterns of critical care unit (CCU) care and the relationship with outcomes in patients with acute decompensated heart failure (ADHF). Whether a ward or a CCU admission is associated with better outcomes is unclear. Patients in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial were initially hospitalized in a ward or CCU (coronary or intensive care unit). Sites were geographically classified: Asia-Pacific (AP), Central Europe (CE), Latin America (LA), North America (NA), and Western-Europe (WE). The primary outcome of 30-day all-cause mortality or all-cause hospital readmission was adjusted using a two-stage multivariable logistic regression model with a generalized estimated equation that took sites within each country as a nested random factor. Overall, 1944 (38.2%) patients were admitted to a CCU and 3150 (61.8%) to a ward, and this varied by region: 50.6% AP, 63.3% CE, 60.7% WE, 22.1% LA, and 28.6% NA. The 30-day death or readmission rate was 15.2% in ward patients and 17.0% in CCU patients (risk-adjusted Odds Ratio [OR] 1.44: 95% CI, 1.14-1.82). Compared with CCU patients in NA (24.1% 30-day event rate), the primary outcomes were: AP (10.4%, Odds Ratio [OR] 0.63; 95% confidence Interval [CI], 0.35 to 1.15), CE (10.4%, OR 0.56: 95% CI, 0.31 to 1.02), LA (22.4%, OR 0.60: 95% CI, 0.11 to 3.32), and WE (11.2%, OR 0.63, 95% CI, 0.25 to 1.56). No regional differences in 30-day mortality were observed; however, 30-day readmission rates were highest in NA sites. Management of patients with ADHF varies significantly, and after adjustment, CCU care was associated with higher risk of early mortality, not explained by international differences. These findings may help to improve the early decisions regarding risk stratification of patients hospitalized with ADHF. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 11/2014; 177(3):840-846. · 6.18 Impact Factor
  • Jane A Cannon, John J V McMurray
    Journal of the American College of Cardiology 11/2014; 64(18):1915-6. · 15.34 Impact Factor
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    ABSTRACT: Resting heart rate (HR) is a predictor of adverse outcome in patients with heart failure (HF). Whether changes in HR over time in patients with chronic HF are also associated with adverse outcome is unknown. We explored the relationship between changes in HR from a preceding visit, time-updated HR (i.e. most recent available HR value from a clinic visit) and subsequent outcomes in patients with chronic HF.
    European Heart Journal 11/2014; · 14.72 Impact Factor
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    ABSTRACT: -Noncardiovascular (non-CV) comorbidities may contribute to hospitalizations in patients with heart failure (HF). We examined the incidence of mortality following hospitalization for cardiovascular (CV) versus non-CV reasons in the CHARM Program.
    Circulation Heart Failure 10/2014; · 6.68 Impact Factor

Publication Stats

34k Citations
5,800.95 Total Impact Points

Institutions

  • 2013–2014
    • Uppsala University
      • • Department of Medical Sciences
      • • UCR-Uppsala Clinical Research center
      Uppsala, Uppsala, Sweden
    • Onze Lieve Vrouwe Gasthuis
      Amsterdamo, North Holland, Netherlands
    • Mario Negri Institute for Pharmacological Research
      Milano, Lombardy, Italy
    • University of Lorraine
      Nancy, Lorraine, France
  • 2004–2014
    • Brigham and Women's Hospital
      • • Division of Cardiovascular Medicine
      • • Center for Brain Mind Medicine
      • • Department of Medicine
      Boston, Massachusetts, United States
    • University of Alberta
      • Department of Medicine
      Edmonton, Alberta, Canada
    • WWF United Kingdom
      Londinium, England, United Kingdom
    • University of Texas Health Science Center at Houston
      • Division of Cardiovascular Medicine (Internal Medicine)
      Houston, TX, United States
  • 1998–2014
    • University of Glasgow
      • • Institute of Cardiovascular and Medical Sciences
      • • BHF Glasgow Cardiovascular Research Centre
      Glasgow, Scotland, United Kingdom
  • 2012–2013
    • Oslo University Hospital
      • • Research Institute of Internal Medicine
      • • Department of Cardiology
      Oslo, Oslo, Norway
    • Baker IDI Heart and Diabetes Institute
      Melbourne, Victoria, Australia
    • Wroclaw Medical University
      • Faculty of Health Science
      Wrocław, Lower Silesian Voivodeship, Poland
  • 2010–2013
    • Centre Hospitalier Universitaire de Nancy
      Nancy, Lorraine, France
    • Monash University (Australia)
      Melbourne, Victoria, Australia
    • Wojskowy Instytut Medyczny
      Warszawa, Masovian Voivodeship, Poland
  • 2008–2013
    • University of Gothenburg
      • The Wallenberg Laboratory for Cardiovascular and Metabolic Research
      Goeteborg, Västra Götaland, Sweden
    • University of Bergen
      • Section of Cardiology
      Bergen, Hordaland, Norway
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Princess Alexandra Hospital (Queensland Health)
      • Division of Medicine
      Brisbane, Queensland, Australia
    • Partners HealthCare
      Boston, Massachusetts, United States
    • University of Melbourne
      Melbourne, Victoria, Australia
  • 2006–2013
    • London School of Hygiene and Tropical Medicine
      • Department of Medical Statistics
      London, ENG, United Kingdom
    • University of Cincinnati
      Cincinnati, Ohio, United States
    • University of Groningen
      Groningen, Groningen, Netherlands
    • University of Liverpool
      • Department of Public Health and Policy
      Liverpool, ENG, United Kingdom
    • Sahlgrenska University Hospital
      Goeteborg, Västra Götaland, Sweden
  • 2003–2013
    • Duke University Medical Center
      • • Department of Medicine
      • • Division of Cardiology
      • • Duke Clinical Research Institute
      Durham, North Carolina, United States
    • Karolinska University Hospital
      Tukholma, Stockholm, Sweden
  • 2010–2012
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2009–2012
    • IT University of Copenhagen
      København, Capital Region, Denmark
    • Stavanger University Hospital
      • Department of Cardiology
      Stavanger, Rogaland Fylke, Norway
    • University of Pennsylvania
      • School of Nursing
      Philadelphia, PA, United States
    • University of Hull
      Kingston upon Hull, England, United Kingdom
    • Duke University
      Durham, North Carolina, United States
    • University of Colorado
      • Division of Cardiology
      Denver, CO, United States
  • 2008–2012
    • Golden Jubilee National Hospital
      Clydebank, Scotland, United Kingdom
  • 2007–2012
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
    • University of Oslo
      • Department of Cardiology
      Kristiania (historical), Oslo County, Norway
  • 2011
    • University of Michigan
      Ann Arbor, Michigan, United States
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
    • East Coast Community Healthcare CIC
      Beccles, England, United Kingdom
    • NHS Greater Glasgow and Clyde
      Glasgow, Scotland, United Kingdom
    • Columbia University
      • Division of Cardiology
      New York City, NY, United States
  • 2010–2011
    • Università degli Studi di Torino
      • Dipartimento di Scienze Mediche
      Torino, Piedmont, Italy
  • 2009–2011
    • Liverpool Heart And Chest Hospital
      Liverpool, England, United Kingdom
  • 2004–2011
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2007–2009
    • Newcastle University
      Newcastle-on-Tyne, England, United Kingdom
  • 2006–2008
    • Montreal Heart Institute
      Montréal, Quebec, Canada
  • 2005–2008
    • Hamilton Health Sciences
      Hamilton, Ontario, Canada
    • McMaster University
      Hamilton, Ontario, Canada
    • Auckland City Hospital
      Окленд, Auckland, New Zealand
  • 2000–2007
    • North Carolina Clinical Research
      Raleigh, North Carolina, United States
    • University of Stirling
      Stirling, Scotland, United Kingdom
  • 2001–2004
    • Glasgow Caledonian University
      • Division of Biomedical Sciences
      Glasgow, SCT, United Kingdom
    • University of Washington Seattle
      • Department of Medicine
      Seattle, WA, United States
  • 2002
    • The Queen Elizabeth Hospital
      • Department of Cardiology
      Adelaide, South Australia, Australia
  • 1994–2000
    • Western General Hospital
      Edinburgh, Scotland, United Kingdom