Impact case study database

The beneficiaries in this case include Boehringer Ingelheim (commercial company benefiting from expanding claims and therefore use of an existing product), veterinary general practitioners (who can target treatment on dogs with asymptomatic DMVD to those where there is now good evidence they will benefit), and the owners and dogs with preclinical DMVD whose health and wellbeing will be improved by application of this treatment at the right stage of their disease.

Up to 1 in 30 dogs in the UK and Europe attend veterinary practices having heart murmurs consistent with DMVD (Egenvall et al, 2006; Mattin et al, 2015).

Pimobendan has been the leading drug used to treat CHF due to DMVD since 2012. The EPIC trial discovered that administration of pimobendan to dogs in preclinical stage B2 prolonged a healthy good quality life by 15 months on average. This enabled BI, in 2017, to obtain regulatory approval to extend the datasheet indications to include dogs with a mitral valve disease murmur and enlarged heart, (stage B2) in Australia, Japan, all EU Countries and China [a]. This extension was widely publicised in the veterinary press and through BI and the RVC [b]. As the first clinical trial to demonstrate unequivocal benefit of therapy in the preclinical stage of DMVD, the work received considerable media attention including international news channel coverage and inclusion in several national daily newspapers and been included in resources prepared by the “Cardiac Education Group” [b]. During this REF period, this case has generated 18,371 unique visitors to the RVC website. The mass media combined coverage exceeds >18,000,000 across countries including UK, USA, Italy, Thailand and India. It has featured in veterinary professional outlets online and/or in print, including Vet Times (circulation 18,000; online 528,256 users); vetsurgeon.org (14,356 online users) and veterinarypracticenews.com (57,000 users). It has also reached dog owning public via mass media such as the Daily Telegraph (circulation 2,600,000; online 8,300,000 users) and Times of India (2,800,000 online users) [b].

The work was recognised as a significant advance in the management of DVMD, by its acceptance into the American College of Veterinary Internal Medicine (ACVIM) consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs [c]. These guidelines credit EPIC with the ability to identify dogs that are likely to benefit substantially from treatment before the onset of clinical signs of heart failure and recommend the use of pimobendan at this stage. The guidelines identify the EPIC trial as the only class 1 category (randomised controlled clinical trial) evidence for a treatment benefit in stage B2, and identify the level of evidence as “strong”. The guidelines also re-defined the B2 stage by adopting EPIC’s specific inclusion criteria, which in turn were informed by RVC research.

The EPIC study additionally demonstrated that treatment enabled dogs to live longer and spend a lower proportion of their life in CHF, and that the risk of a dog experiencing heart failure was reduced by approximately one third, all of which contribute to enhanced quality of life for the dogs and their owners ( Freeman et al, 2005).

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The RVC research into how B2 can be identified in primary care practice without requiring expert echocardiographic evaluation, stimulated BI to support the RVC-led international multicentre HAMLET study [a]. Based on the study results, RVC filed a patent application on 7 April 2020 for an algorithm to determine the probability that a dog is in stage B2 and, therefore, whether it is likely to benefit from pimobendan [d]. [Text removed for publication]. The use of this app will enable primary care practitioners to target pimobendan treatment on those asymptomatic dogs with mitral valve murmurs that are most likely to benefit, without the need to refer them to expert cardiologists to determine which dogs are in stage B2.