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Dr Sinead McDonagh

Research Fellow

2758

+44 (0) 1392 722758

Smeall building 110

Smeall Building, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK

Overview

Sinead completed her BSc in Sport Sciences at Brunel University in 2011. She then moved to the University of Exeter to study for a MSc in Sport and Exercise Medicine.

During her time as a Masters student, Sinead became very interested in the effects of dietary nitrate supplementation and lifestyle choices on cardiovascular health and exercise tolerance and went on to pursue a PhD in this area.

In 2017, Sinead joined the University of Exeter Medical School Primary Care department as a Postdoctoral Research Fellow where her research focuses on the detection and management of postural hypotension, hypertension and atrial fibrillation in primary care and the implementation of a home-based cardiac rehabilitation programme (REACH-HF) in the NHS.

Qualifications

BSc Sport Sciences (Brunel University)
MSc Sport and Exercise Medicine (University of Exeter)
PhD Exetercise Physiology and Nutrition (University of Exeter)
AFHEA

Research

Research interests

Recognition and management of postural hypotension in primary care
Improving blood pressure control in patients with hypertension
Significance and implications of a difference in blood pressures between arms
Lowering blood pressure and improving exercise capacity through dietary nitrate supplementation
Heart failure and cardiac rehabilitation
Cardiovascular Physiology
Access to primary care
Multimorbidity and decision making about healthcare

Research projects

DROP: Detecting risks of postural hypotension

Cochrane Review: Allied health professional-led interventions for improving control of blood pressure in patients with hypertension

INTERPRESS-IPD: The inter-arm blood pressure difference individual patient data collaborations

ABLE-BP: Arm Based on LEg Blood Pressure: An individual participant data mea-analysis using data from the INTERPRESS-IPD Collaboration

REACH-HF: Rehabilitation Enablement in Chronic Heart Failure

ImPULSE: Sensitivity and specificity of a mobile lead-one ECG like device for the detection of Atrial Fibrillation

Cochrane Review: Interventions for involving older patients with multimorbidity in decision-making during primary care consultations

Cochrane Review: Home vs. centre based cardiac rehabilitation

RETAIN: Recruitment and retention of staff in rural dispensing practice

Group-based interventions for hypertension care

Conferences

McDonagh STJ, Sheppard J, Warren F, Boddy K, Farmer L, Shore H, Williams P, Lewis PS, Baumber R, Fordham AJ, Martin U, Aboyans V, Clark CE. (2021). Arm Based on LEg blood pressures (ABLE-BP): Can leg blood pressure measurements predict brachial blood pressure? An individual participant data meta-analysis from the INTERPRESS-IPD Collaboration. Oral presentation at South West Society for Academic Primary Care Conference, Warwick (online conference).

McDonagh STJ, Dalal H, van Beurden S, Daw P , Greaves C, Doherty P, Taylor RS, on behalf of the REACH-HF Study Investigators. (2020). REACH-HF Beacon Site Project: Developing and evaluating a network of practice for the implementation of home-based heart failure rehabilitation across the UK. Poster presentation at the Cardiovascular Disease Prevention Conference, London.

McDonagh STJ, Sheppard J, Warren F, Boddy K, Farmer L, Lewis P, Baumber R, Martin U, Clark CE. (2020). Arm Based on LEg blood pressures (ABLE-BP): Can leg blood pressure measurements predict brachial blood pressure? An individual participant data meta-analysis from the INTERPRESS-IPD Collaboration. Oral presentation at South West Society for Academic Primary Care Conference, Bristol.

McDonagh STJ, Norris B, Fordham AJ, Greenwood MR, Richards SH, Campbell JL, Clark CE. (2019). Impact of inter-arm blood pressure difference on cardiovascular risk estimation in primary care. Poster presentation at the British and Irish Hypertension Society Conference, Birmingham.

McDonagh STJ, Norris B, Fordham AJ, Greenwood MR, Richards SH, Campbell JL, Clark CE. (2019). Impact of inter-arm blood pressure difference on cardiovascular risk estimation in primary care. Oral presentation at the Society for Academic Primary Care Conference, Exeter.

McDonagh STJ, Norris B, Fordham AJ, Greenwood MR, Richards SH, Campbell JL, Clark CE. (2019). Impact of inter-arm blood pressure difference on cardiovascular risk estimation in primary care. Poster presentation at the European Society of Hypertension Conference, Milan.

McDonagh STJ, Norris B, Fordham AJ, Greenwood MR, Richards SH, Campbell JL, Clark CE. (2019). Impact of inter-arm blood pressure difference on cardiovascular risk estimation in primary care. Oral presentation at the South West Society for Academic Primary Care Conference, Southampton.

McDonagh STJ, Mejzner N, Clark, CE. (2018). Prevalence of postural hypotension in primary, community and institutional care: A systematic review and meta-analysis. Poster presentation at the British and Irish Hypertension Society Conference, Cambridge.

Clark CE, Smith LFP, Cloutier L, Konya J, Todkar SK, McDonagh STJ, Clark OM, Glynn LG, Taylor RS, Campbell J. (2018). Interventions to improve control of hypertension; what works (and what doesn’t)? Poster presentation at the British and Irish Hypertension Society Conference, Cambridge.

Clark CE, McDonagh STJ, McManus RJ. (2018) Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis. Poster presentation at the British and Irish Hypertension Society Conference, Cambridge.

McDonaghSTJ, Mejzner N, Clark CE. Prevalence of postural hypotension in primary, community and institutional care: A systematic review and meta-analysis. Oral presentation at the 2018 Society for Academic Primary Care Conference, London.

McDonaghSTJ, Mejzner N, Clark CE. Prevalence of postural hypotension in primary, community and institutional care: A systematic review and meta-analysis. Oral presentation at the 2018 South West Society for Academic Primary Care Conference, Plymouth.

McDonagh STJ, Vanhatalo A, Fulford J, Wylie LJ, Bailey SJ, Jones AM. (2015). Effects of blood donation and nitrate ingestion on the physiological response to moderate-intensity and incremental exercise. Oral presentation at the 2015 Physiological Society Conference, Cardiff.

McDonagh STJ, Wylie LJ, Winyard PG, Vanhatalo A, Jones AM (2014). Antibacterial mouthwash attenuates the physiological effects of chronic nitrate supplementation in humans. Mini Oral presentation at the 2014 ECSS Annual Conference.

McDonagh STJ, Wylie LJ, Winyard PG, Vanhatalo A, Jones AM (2014). Antibacterial mouthwash attenuates the physiological effects of chronic nitrate supplementation in humans. Oral presentation at the 2014 GSSI Nutrition Award ECSS Annual Conference.

McDonagh STJ, Wylie LJ, Winyard PG, Vanhatalo A, Jones AM (2014). Antibacterial mouthwash attenuates the physiological effects of chronic nitrate supplementation in humans. Oral presentation at the 2014 BASES Student Conference.

Academic Awards

Above & Beyond nomination by Professor Rod Taylor, Professor Colin Greaves and Dr Hasnain Dalal for contribution to REACH-HF. University of Exeter, 2020.

The BMJ Awards. REACH-HF shortlisted in the Stroke and Cardiovascular category, April 2020.

National Institute for Health Research (NIHR) South West Research Awards. REACH-HF nominated for the ‘Innovation Award’ and ‘Outstanding Research Contribution Team Award’, February 2020.

Young Investigator Placement Programme Award to visit University of Oxford. British and Irish Hypertension Society, 2019.

Young Investigator Bursary for attendance and presentation of two posters at the British and Irish Hypertension Society Conference 2019, Birmingham.

Above & Beyond nomination by Dr Christopher Clark for contribution to ‘Allied health professional-led interventions for improving control of blood pressure in patients with hypertension’ Cochrane review. University of Exeter, 2018.

Young Investigator Bursary for attendance and presentation of three posters at the British and Irish Hypertension Society Conference 2018, Cambridge.

Gatorade Sports Science Institute (GSSI) Nutrition Award winner at the European College of Sport Sciences (ECSS) Conference 2015, Malmö. ‘Effects of blood donation and nitrate ingestion on the physiological response to moderate-intensity and incremental exercise’.

Gatorade Sports Science Institute (GSSI) Nutrition Award Finalist at the European College of Sport Sciences (ECSS) Conference 2014, Amsterdam. ‘Antibacterial mouthwash attenuates the physiological effects of chronic nitrate supplementation in humans’.

Recipient of the 2010-2011 Brunel University Best Undergraduate Dissertation Award for thesis entitled “Effects of Short Term Plyometric Training on Bone Mineral Density, Bone Mineral Content and Body Composition of Males in Non-Weight Bearing Sports’.

Recipient of the 2010-2011 Physiological Society Undergraduate Dissertation Award.

Recipient of the 2010-2011 Ede & Ravenscroft Undergraduate Dissertation Prize.

Research grants

2020 National Institute for Health Research
We will develop a digitally delivered version of the training course for the REACH-HF home-based cardiac rehabilitation programme. We aim to test the feasibility and acceptability of the revised training and compare the resulting quality of delivery with benchmarks set in the REACH-HF trial. This will ensure that quality of intervention delivery can be maintained when moving to a less intensive training format.
2020 SW AHSN
The aim of this project was to adapt the home-based cardiac rehabilitation (REACH-HF) healthcare professional training programme so that it could be delivered online during the COVID-19 pandemic. This enabled clinicians to provide heart failure patients and caregivers an alternative to rehabilitation classes that are traditionally provided in hospital or community centres but are currently unavailable during the COVID-19 outbreak.
2020 BHF Research Project
The aim of this project is to create a digital version of the home-based cardiac rehabilitation programme for patients with heart failure (REACH-HF) to improve patient choice of, and accessibility to, cardiac rehabilitation.
2019 The Stroke Association
Using data from the INTERPRESS-IPD Collaboration, which holds >33,000 individual records from 14 international studies, we aim to i) examine the relationship between arm and leg blood pressure; ii) develop and validate a multivariable model predicting arm blood pressure from leg blood pressure; iii) investigate the prognostic role of leg blood pressure in cardiovascular event and mortality risk prediction.
2019 The Thalidomide Trust
The aim of this project is to support Thalidomide Trust beneficiaries in collaborating with researchers, as public advisors, in determining the relationship between arm and leg blood pressure using an IPD meta-analysis (project funded by the Stroke Association)
2019 National Centre for Rural Health and Care
The aim of this study is to understand the facilitators of, and barriers to, taking up and/or remaining in rural dispensing primary care employment. We also aim to elucidate the value placed on dispensing from the perspectives of the multidisciplinary team.

Publications

Key publications | Publications by category | Publications by year

Key publications

McDonagh STJ, Mejzner N, Clark CE (2021). Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis. BMC Family Practice, 22(1).

Abstract
. Background
. Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying 0to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups.
.
. Methods
. Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale.
.
. Results
. One thousand eight hundred sixteen studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14–20%; I2 = 99%) for 34 community cohorts, 19% (15–25%; I2 = 98%) for 23 primary care cohorts and 31% (15–50%; I2 = 0%) for 3 residential care or nursing homes cohorts (P = 0.16 between groups). By condition, prevalences were 20% (16–23%; I2 = 98%) with hypertension (20 cohorts), 21% (16–26%; I2 = 92%) with diabetes (4 cohorts), 25% (18–33%; I2 = 88%) with Parkinson’s disease (7 cohorts) and 29% (25–33%, I2 = 0%) with dementia (3 cohorts), compared to 14% (12–17%, I2 = 99%) without these conditions (P < 0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P < 0.01, P = 0.13, respectively; R2 = 36%). PH prevalence was not affected by blood pressure measurement device (P = 0.65) or sitting or supine resting position (P = 0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P = 0.01) irrespective of study quality (P = 0.04).
.
. Conclusions
. PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH.
. PROSPERO:CRD42017075423.
.

Abstract. Full text.

Clark C, Warren F, Boddy K, McDonagh S, Moore S, Goddard J, Reed N, Turner M, Alzamora MT, Ramos Blanes R, et al (2020). Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality: Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: the INTERPRESS-IPD Collaboration. Hypertension, n/a, 1-12. Full text.

Butterworth JE, Hays R, McDonagh STJ, Bower P, Pitchforth E, Richards SH, Campbell JL (2020). Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged). Patient Educ Couns, 103(10), 2078-2094. Abstract. Author URL.

McDonagh STJ (2018). Factors influencing the effects of dietary nitrate supplementation on nitric oxide biomarkers and blood pressure.

Ingestion of nitrate (NO3-) from natural sources can improve indices of cardiovascular health and exercise tolerance. The aim of this thesis was to determine the impact of dietary NO3- as a therapeutic aid when consumed amongst factors that might affect its efficacy such as antibacterial mouthwash, blood donation, different food forms and co-ingestion with alcoholic beverages. Young, healthy, normotensive individuals volunteered to participate in each experiment and undergo an array of physiological assessments. Chapter 4: Mouth rinsing with chlorhexidine and non-chlorhexidine mouthwash prior to consumption of concentrated NO3--rich beetroot juice (BR), over 6 days, blunted the rise in plasma nitrite concentration ([NO2-]) by 53 % and 29 % respectively, compared with control. Chlorhexidine mouthwash also elevated systolic (SBP) and mean arterial (MAP) blood pressure (BP) during treadmill walking. Chapter 5: Short-term BR ingestion lowered the oxygen (O2) cost of moderate-intensity exercise (by ~ 4 %), better preserved muscle oxygenation and attenuated the decline in incremental exercise tolerance (by 5 %) following whole blood donation. Chapter 6: an array of different NO3--rich vehicles, including BR, beetroot flapjack (BF), non-concentrated beetroot juice (BL) and beetroot crystals (BC), elevated salivary, plasma and urinary NO3- concentration ([NO3-]) and [NO2-] when compared with baseline and control, with the largest increases in plasma [NO2-] occurring in BF and BR. BR also reduced SBP (~5 mmHg) and MAP (~ 3-4 mmHg), and BF reduced diastolic BP (DBP; ~ 4 mmHg). Chapter 7: a high NO3- salad, accompanied by polyphenol-rich (NIT-RW) and -low (NIT-A) alcoholic beverages and a water control (NIT-CON) elevated salivary, plasma and urinary [NO3-] and [NO2-] compared with control (CON). SBP was reduced 2 h post consumption of NIT-RW (-4 mmHg), NIT-A (-3 mmHg) and NIT-CON (-2 mmHg) compared with CON. DBP and MAP were also lower in NIT-A, and more so in NIT-RW, compared with NIT-CON.
Overall, the findings in this thesis demonstrate the efficacy of naturally derived NO3- on NO metabolites, BP and exercise tolerance. The potential for such benefits to arise may be maximised if antibacterial mouthwash is avoided during supplementation and if NO3- is consumed as BR, BF or as a green leafy salad with or without an alcoholic beverage. It may also be suggested that NO3- ingestion can offset decrements in exercise tolerance following blood donation.

Abstract. Full text.

Publications by category

Journal articles

McDonagh STJ, Wylie LJ, Morgan P, Vanhatalo A, Jones A (In Press). A randomised controlled trial exploring the effects of different beverages consumed alongside a nitrate-rich meal on systemic blood pressure. Nutrition and Health

McDonagh S, Clark CE (In Press). Inter-arm differences in blood pressure: a brief summary. Diabetes and Primary Care, 21 Full text.

McDonagh STJ, Mejzner N, Clark CE (In Press). Prevalence of Postural Hypotension in Primary, Community and Institutional Care: a Systematic Review and Meta-Analysis.

Abstract
. Background: Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care despite these associated risks. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups.Methods: a systematic review, meta-analyses and meta-regression were undertaken. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean prevalence of PH were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment of included studies was undertaken using an adapted version of the Newcastle-Ottawa Scale.Results: 1816 studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%) in the community, 19% (15-25%) in primary care and 31% (15-50%) in residential care or nursing homes (P=0.16 between groups). By condition, prevalences were 20% (16-24%) with hypertension, 21% (16-26%) with diabetes, 25% (18-33%) with Parkinson’s disease and 29% (25-33%) with dementia, compared to 14% (12-17%) without these conditions (P<0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P<0.01, P=0.13, respectively; R2=36%). PH prevalence was not affected by blood pressure measurement device (P=0.65) or sitting or supine resting position (P=0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P=0.01) irrespective of study quality (P=0.04).Conclusions: the prevalence of PH in populations relevant to primary care is substantial. The definition used is important when testing for PH. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of postural hypotension.PROSPERO: CRD42017075423.

Abstract.

McDonagh STJ, Mejzner N, Clark CE (In Press). Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis.

Abstract
. Background: Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups.
Methods: Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale.
Results: 1816 studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%; I2=99%) for community cohorts, 19% (15-25%; I2=98%) for 23 primary care cohorts and 31% (15-50%; I2=0%) for 3 residential care or nursing homes cohorts (P=0.16 between groups). By condition, prevalences were 20% (16-23%; I2=98%) with hypertension (20 cohorts), 21% (16-26%; I2=92%) with diabetes (4 cohorts), 25% (18-33%; I2=88%) with Parkinson’s disease (7 cohorts) and 29% (25-33%; I2=0%) with dementia (3 cohorts), compared to 14% (12-17%; I2=99%) without these conditions (P<0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P<0.01, P=0.13, respectively; R2=36%). PH prevalence was not affected by blood pressure measurement device (P=0.65) or sitting or supine resting position (P=0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P=0.01) irrespective of study quality (P=0.04).
Conclusions: PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH.
PROSPERO:CRD42017075423.

Abstract.

McDonagh STJ, Sheppard JP, Warren FC, Boddy K, Farmer L, Shore H, Williams P, Lewis PS, Baumber R, Fordham J, et al (2021). Arm Based on LEg blood pressures (ABLE-BP): can systolic leg blood pressure measurements predict systolic brachial blood pressure? Protocol for an individual participant data meta-analysis from the INTERPRESS-IPD Collaboration. BMJ Open, 11(3), e040481-e040481. Abstract. Full text.

Clark CE, McDonagh STJ, McManus RJ, Martin U (2021). COVID-19 and hypertension: risks and management. A scientific statement on behalf of the British and Irish Hypertension Society. J Hum Hypertens, 35(4), 304-307. Author URL.

McDonagh STJ, Mejzner N, Clark CE (2021). Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis. BMC Family Practice, 22(1).

Abstract. Full text.

Abu-Alghayth M, Vanhatalo A, Wylie LJ, McDonagh STJ, Thompson C, Kadach S, Kerr P, Smallwood MJ, Jones AM, Winyard PG, et al (2021). S-nitrosothiols, and other products of nitrate metabolism, are increased in multiple human blood compartments following ingestion of beetroot juice. Redox Biology, 43, 101974-101974.

Taylor RS, Dalal HM, McDonagh STJ (2021). The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology

Dalal H, Taylor RS, Greaves C, Doherty PJ, McDonagh ST, van Beurden SB, Purcell C (2020). Correspondence to the EJPC in response to position paper by Ambrosetti M et al. 2020. Eur J Prev Cardiol Author URL.

Dalal H, Taylor RS, Greaves C, Doherty PJ, McDonagh ST, van Beurden SB, Purcell C, REACH-HF Study Group (2020). Correspondence to the EJPC in response to position paper by Ambrosetti M et al. 2020: Cardiovascular rehabilitation and COVID-19: the need to maintain access to evidence-based services from the safety of home. Eur J Prev Cardiol Author URL.

Albasri A, Clark C, Omboni S, McDonagh S, McManus RJ, Sheppard JO (2020). Effective detection and management of hypertension through community pharmacy in England. Pharmaceutical Journal Full text.

Daw P, van Beurden SB, Greaves C, Veldhuijzen van Zanten JJCS, Harrison A, Dalal H, McDonagh STJ, Doherty PJ, Taylor RS (2020). Getting evidence into clinical practice: protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure. BMJ Open, 10(6), e036137-e036137.

IntroductionCardiac rehabilitation (CR) improves health-related quality of life and reduces hospital admissions. However, patients with heart failure (HF) often fail to attend centre-based CR programmes. Novel ways of delivering healthcare, such as home-based CR programmes, may improve uptake of CR. Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is a new, effective and cost-effective home-based CR programme for people with HF. The aim of this prospective mixed-method implementation evaluation study is to assess the implementation of the REACH-HF CR programme in the UK National Health Service (NHS). The specific objectives are to (1) explore NHS staff perceptions of the barriers and facilitators to the implementation of REACH-HF, (2) assess the quality of delivery of the programme in real-life clinical settings, (3) consider the nature of any adaptation(s) made and how they might impact on intervention effectiveness and (4) compare real-world patient outcomes to those seen in a prior clinical trial.Methods and analysisREACH-HF will be rolled out in four NHS CR centres across the UK. Three healthcare professionals from each site will be trained to deliver the 12-week programme. In-depth qualitative interviews and focus groups will be conducted with approximately 24 NHS professionals involved in delivering or commissioning the programme. Consultations for 48 patients (12 per site) will be audio recorded and scored using an intervention fidelity checklist. Outcomes routinely recorded in the National Audit of Cardiac Rehabilitation will be analysed and compared with outcomes from a recent randomised controlled trial: the Minnesota Living with HF Questionnaire and exercise capacity (Incremental Shuttle Walk Test). Qualitative research findings will be mapped onto the Normalisation Process Theory framework and presented in the form of a narrative synthesis. Results of the study will inform national roll-out of REACH-HF.Ethics and disseminationThe study (IRAS 261723) has received ethics approval from the South Central (Hampshire B) Research Ethics Committee (19/SC/0304). Written informed consent will be obtained from all health professionals and patients participating in the study. The research team will ensure that the study is conducted in accordance with the Declaration of Helsinki, the Data Protection Act 2018, General Data Protection Regulations and in accordance with the Research Governance Framework for Health and Social Care (2005). Findings will be published in scientific peer-reviewed journals and presented at local, national and international meetings to publicise and explain the research methods and findings to key audiences to facilitate the further uptake of the REACH-HF intervention.

Abstract. Full text.

Clark CE, McDonagh STJ, McManus RJ, Worki BPM (2020). Measurement of blood pressure in people with atrial fibrillation (vol 33, pg 763, 2019). JOURNAL OF HUMAN HYPERTENSION, 34(6), 476-476. Author URL.

Sheppard JP, Lacy P, Lewis PS, Martin U (2020). Measurement of blood pressure in the leg—a statement on behalf of the British and Irish Hypertension Society. Journal of Human Hypertension, 34(6), 418-419. Full text.

Wise J (2020). The BMJ Awards 2020: Stroke and cardiovascular team of the year. BMJ-BRITISH MEDICAL JOURNAL, 368 Author URL.

Limb M (2020). The BMJ Awards 2020: showcase of this year’s winning teams. BMJ, m4341-m4341.

Schwartz CL, Edwards K, Gamble W, Kirkham A, Lacy P, Lewis P, McDonagh STJ, Peers C, Sheppard JP, Swales P, et al (2020). Validation of the Kinetik Blood Pressure Monitor-Series 1 for use in adults at home and in clinical settings, according to the 2002 European Society of Hypertension International Protocol on the validation of blood pressure devices. J Hum Hypertens Abstract. Author URL.

Clark CE, McDonagh STJ, McManus RJ (2019). Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis. J Hum Hypertens, 33(5), 352-364. Abstract. Author URL. Full text.

McDonagh S, Clark C (2019). CVD risk factors: new evidence, new approaches?. Primary Care Cardiovascular Journal

Butterworth JE, Hays R, McDonagh STJ, Richards SH, Bower P, Campbell J (2019). Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations. Cochrane Database of Systematic Reviews Full text.

Clark CE, McDonagh STJ, McManus RJ, Blood Pressure Measurement Working Party of the British and Irish Hypertension Society (2019). Measurement of blood pressure in people with atrial fibrillation. J Hum Hypertens, 33(11), 763-765. Author URL.

McDonagh STJ, Wylie LJ, Thompson C, Vanhatalo A, Jones AM (2019). Potential benefits of dietary nitrate ingestion in healthy and clinical populations: a brief review. Eur J Sport Sci, 19(1), 15-29. Abstract. Author URL.

Clark IE, Goulding RP, DiMenna FJ, Bailey SJ, Jones MI, Fulford J, McDonagh STJ, Jones AM, Vanhatalo A (2019). Time-trial performance is not impaired in either competitive athletes or untrained individuals following a prolonged cognitive task. Eur J Appl Physiol, 119(1), 149-161. Abstract. Author URL. Full text.

McDonagh STJ, Wylie LJ, Webster JMA, Vanhatalo A, Jones AM (2018). Influence of dietary nitrate food forms on nitrate metabolism and blood pressure in healthy normotensive adults. Nitric Oxide, 72, 66-74. Abstract. Author URL.

Thompson C, Wylie LJ, Blackwell JR, Fulford J, Black MI, Kelly J, McDonagh STJ, Carter J, Bailey SJ, Vanhatalo A, et al (2017). Influence of dietary nitrate supplementation on physiological and muscle metabolic adaptations to sprint interval training. J Appl Physiol (1985), 122(3), 642-652.

We hypothesized that 4 wk of dietary nitrate supplementation would enhance exercise performance and muscle metabolic adaptations to sprint interval training (SIT). Thirty-six recreationally active subjects, matched on key variables at baseline, completed a series of exercise tests before and following a 4-wk period in which they were allocated to one of the following groups: 1) SIT and [Formula: see text]-depleted beetroot juice as a placebo (SIT+PL); 2) SIT and [Formula: see text]-rich beetroot juice (~13 mmol [Formula: see text]/day; SIT+BR); or 3) no training and [Formula: see text]-rich beetroot juice (NT+BR). During moderate-intensity exercise, pulmonary oxygen uptake was reduced by 4% following 4 wk of SIT+BR and NT+BR (P < 0.05) but not SIT+PL. The peak work rate attained during incremental exercise increased more in SIT+BR than in SIT+PL (P < 0.05) or NT+BR (P < 0.001). The reduction in muscle and blood [lactate] and the increase in muscle pH from preintervention to postintervention were greater at 3 min of severe-intensity exercise in SIT+BR compared with SIT+PL and NT+BR (P < 0.05). However, the change in severe-intensity exercise performance was not different between SIT+BR and SIT+PL (P > 0.05). The relative proportion of type IIx muscle fibers in the vastus lateralis muscle was reduced in SIT+BR only (P < 0.05). These findings suggest that BR supplementation may enhance some aspects of the physiological adaptations to SIT.NEW & NOTEWORTHY We investigated the influence of nitrate-rich and nitrate-depleted beetroot juice on the muscle metabolic and physiological adaptations to 4 wk of sprint interval training. Compared with placebo, dietary nitrate supplementation reduced the O2 cost of submaximal exercise, resulted in greater improvement in incremental (but not severe-intensity) exercise performance, and augmented some muscle metabolic adaptations to training. Nitrate supplementation may facilitate some of the physiological responses to sprint interval training.

Abstract. Author URL. Full text.

Black MI, Jones AM, Blackwell JR, Bailey SJ, Wylie LJ, McDonagh STJ, Thompson C, Kelly J, Sumners P, Mileva KN, et al (2017). Muscle metabolic and neuromuscular determinants of fatigue during cycling in different exercise intensity domains. J Appl Physiol (1985), 122(3), 446-459.

Lactate or gas exchange threshold (GET) and critical power (CP) are closely associated with human exercise performance. We tested the hypothesis that the limit of tolerance (Tlim) during cycle exercise performed within the exercise intensity domains demarcated by GET and CP is linked to discrete muscle metabolic and neuromuscular responses. Eleven men performed a ramp incremental exercise test, 4-5 severe-intensity (SEV; >CP) constant-work-rate (CWR) tests until Tlim, a heavy-intensity (HVY; GET) CWR test until Tlim, and a moderate-intensity (MOD;. 0.05) muscle metabolic milieu (i.e. low pH and [PCr] and high [lactate]) was attained at Tlim (approximately 2-14 min) for all SEV exercise bouts. The muscle metabolic perturbation was greater at Tlim following SEV compared with HVY, and also following SEV and HVY compared with MOD (all P < 0.05). The normalized M-wave amplitude for the vastus lateralis (VL) muscle decreased to a similar extent following SEV (-38 ± 15%), HVY (-68 ± 24%), and MOD (-53 ± 29%), (P > 0.05). Neural drive to the VL increased during SEV (4 ± 4%; P < 0.05) but did not change during HVY or MOD (P > 0.05). During SEV and HVY, but not MOD, the rates of change in M-wave amplitude and neural drive were correlated with changes in muscle metabolic ([PCr], [lactate]) and blood ionic/acid-base status ([lactate], [K+]) (P < 0.05). The results of this study indicate that the metabolic and neuromuscular determinants of fatigue development differ according to the intensity domain in which the exercise is performed.NEW & NOTEWORTHY the gas exchange threshold and the critical power demarcate discrete exercise intensity domains. For the first time, we show that the limit of tolerance during whole-body exercise within these domains is characterized by distinct metabolic and neuromuscular responses. Fatigue development during exercise greater than critical power is associated with the attainment of consistent "limiting" values of muscle metabolites, whereas substrate availability and limitations to muscle activation may constrain performance at lower intensities.

Abstract. Author URL. Full text.

McDonagh STJ, Vanhatalo A, Fulford J, Wylie LJ, Bailey SJ, Jones AM (2016). Dietary nitrate supplementation attenuates the reduction in exercise tolerance following blood donation. Am J Physiol Heart Circ Physiol, 311(6), H1520-H1529. Abstract. Author URL. Full text.

Thompson C, Wylie LJ, Fulford J, Kelly J, Black MI, McDonagh STJ, Jeukendrup AE, Vanhatalo A, Jones AM (2015). Dietary nitrate improves sprint performance and cognitive function during prolonged intermittent exercise. Eur J Appl Physiol, 115(9), 1825-1834. Abstract. Author URL. Full text.

McDonagh STJ, Wylie LJ, Winyard PG, Vanhatalo A, Jones AM (2015). The Effects of Chronic Nitrate Supplementation and the Use of Strong and Weak Antibacterial Agents on Plasma Nitrite Concentration and Exercise Blood Pressure. Int J Sports Med, 36(14), 1177-1185. Abstract. Author URL.

Conferences

Daw P, van Zanten JV, Harrison A, Dalal H, Taylor RS, Doherty PJ, McDonagh STJ, Greaves CJ (2020). Pragmatic parallel mixed methods investigation into implementation of home-based cardiac rehabilitation for heart failure patients: methodological discussion. Author URL.

Publications by year

In Press

McDonagh S, Clark CE (In Press). Inter-arm differences in blood pressure: a brief summary. Diabetes and Primary Care, 21 Full text.

McDonagh STJ, Mejzner N, Clark CE (In Press). Prevalence of Postural Hypotension in Primary, Community and Institutional Care: a Systematic Review and Meta-Analysis.

Abstract.

McDonagh STJ, Mejzner N, Clark CE (In Press). Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis.

Abstract
. Background: Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups.
Methods: Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale.
Results: 1816 studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%; I2=99%) for community cohorts, 19% (15-25%; I2=98%) for 23 primary care cohorts and 31% (15-50%; I2=0%) for 3 residential care or nursing homes cohorts (P=0.16 between groups). By condition, prevalences were 20% (16-23%; I2=98%) with hypertension (20 cohorts), 21% (16-26%; I2=92%) with diabetes (4 cohorts), 25% (18-33%; I2=88%) with Parkinson’s disease (7 cohorts) and 29% (25-33%; I2=0%) with dementia (3 cohorts), compared to 14% (12-17%; I2=99%) without these conditions (P<0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P<0.01, P=0.13, respectively; R2=36%). PH prevalence was not affected by blood pressure measurement device (P=0.65) or sitting or supine resting position (P=0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P=0.01) irrespective of study quality (P=0.04).
Conclusions: PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH.
PROSPERO:CRD42017075423.

Abstract.

2021

McDonagh STJ, Mejzner N, Clark CE (2021). Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis. BMC Family Practice, 22(1).

Abstract. Full text.

Taylor RS, Dalal HM, McDonagh STJ (2021). The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology

2020

Abstract. Full text.

Wise J (2020). The BMJ Awards 2020: Stroke and cardiovascular team of the year. BMJ-BRITISH MEDICAL JOURNAL, 368 Author URL.

Limb M (2020). The BMJ Awards 2020: showcase of this year’s winning teams. BMJ, m4341-m4341.

2019

McDonagh S, Clark C (2019). CVD risk factors: new evidence, new approaches?. Primary Care Cardiovascular Journal

2018

McDonagh STJ (2018). Factors influencing the effects of dietary nitrate supplementation on nitric oxide biomarkers and blood pressure.

Abstract. Full text.

2017

Abstract. Author URL. Full text.

2016

2015

Sinead_McDonagh Details from cache as at 2021-09-27 00:50:53

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Teaching

Sinead has an interest in physiology and has had the opportunity to teach and provide feedback to students on a number of different undergraduate physiology modules over 4 years (see below). She has also conducted individual and group workshops for students aiming to improve their writing skills and understanding of basic chemistry and biology.

ESS1502 Sports Training Physiology
ESS1703 Bioenergetics
ESS1005 Foundations of Exercise Physiology
ESS1007 Human Physiology
ESS1506 Foundations of Sports Nutrition
ESS2001 Exercise Physiology
ESS2502 Exercise Programming
ESS3302 Dissertation

Supervision / Group

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Profile

Dr Sinead McDonagh

Research Fellow

Overview

Qualifications

Research

Research interests

Research projects

Conferences

Academic Awards

Research grants

Publications

Key publications

Abstract:Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

Abstract:Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged).

Abstract:Factors influencing the effects of dietary nitrate supplementation on nitric oxide biomarkers and blood pressure

Publications by category

Journal articles

Abstract:Prevalence of Postural Hypotension in Primary, Community and Institutional Care: a Systematic Review and Meta-Analysis

Abstract:Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

Abstract:Arm Based on LEg blood pressures (ABLE-BP): can systolic leg blood pressure measurements predict systolic brachial blood pressure? Protocol for an individual participant data meta-analysis from the INTERPRESS-IPD Collaboration

Abstract:Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

Abstract:Getting evidence into clinical practice: protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure

Abstract:Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged).

Abstract:Validation of the Kinetik Blood Pressure Monitor-Series 1 for use in adults at home and in clinical settings, according to the 2002 European Society of Hypertension International Protocol on the validation of blood pressure devices.

Abstract:Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis.

Abstract:Potential benefits of dietary nitrate ingestion in healthy and clinical populations: a brief review.

Abstract:Time-trial performance is not impaired in either competitive athletes or untrained individuals following a prolonged cognitive task.

Abstract:Influence of dietary nitrate food forms on nitrate metabolism and blood pressure in healthy normotensive adults.

Abstract:Influence of dietary nitrate supplementation on physiological and muscle metabolic adaptations to sprint interval training.

Abstract:Muscle metabolic and neuromuscular determinants of fatigue during cycling in different exercise intensity domains.

Abstract:Dietary nitrate supplementation attenuates the reduction in exercise tolerance following blood donation.

Abstract:Dietary nitrate improves sprint performance and cognitive function during prolonged intermittent exercise.

Abstract:The Effects of Chronic Nitrate Supplementation and the Use of Strong and Weak Antibacterial Agents on Plasma Nitrite Concentration and Exercise Blood Pressure.

Conferences

Publications by year

In Press

Abstract:Prevalence of Postural Hypotension in Primary, Community and Institutional Care: a Systematic Review and Meta-Analysis

Abstract:Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

2021

Abstract:Arm Based on LEg blood pressures (ABLE-BP): can systolic leg blood pressure measurements predict systolic brachial blood pressure? Protocol for an individual participant data meta-analysis from the INTERPRESS-IPD Collaboration

Abstract:Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

2020

Abstract:Getting evidence into clinical practice: protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure

Abstract:Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged).

Abstract:Validation of the Kinetik Blood Pressure Monitor-Series 1 for use in adults at home and in clinical settings, according to the 2002 European Society of Hypertension International Protocol on the validation of blood pressure devices.

2019

Abstract:Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis.

Abstract:Potential benefits of dietary nitrate ingestion in healthy and clinical populations: a brief review.

Abstract:Time-trial performance is not impaired in either competitive athletes or untrained individuals following a prolonged cognitive task.

2018

Abstract:Factors influencing the effects of dietary nitrate supplementation on nitric oxide biomarkers and blood pressure

Abstract:Influence of dietary nitrate food forms on nitrate metabolism and blood pressure in healthy normotensive adults.

2017

Abstract:Influence of dietary nitrate supplementation on physiological and muscle metabolic adaptations to sprint interval training.

Abstract:Muscle metabolic and neuromuscular determinants of fatigue during cycling in different exercise intensity domains.

2016

Abstract:Dietary nitrate supplementation attenuates the reduction in exercise tolerance following blood donation.

2015

Abstract:Dietary nitrate improves sprint performance and cognitive function during prolonged intermittent exercise.

Abstract:The Effects of Chronic Nitrate Supplementation and the Use of Strong and Weak Antibacterial Agents on Plasma Nitrite Concentration and Exercise Blood Pressure.

Teaching

Supervision / Group

Abstract:
Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

Abstract:
Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged).

Abstract:
Factors influencing the effects of dietary nitrate supplementation on nitric oxide biomarkers and blood pressure

Abstract:
Prevalence of Postural Hypotension in Primary, Community and Institutional Care: a Systematic Review and Meta-Analysis

Abstract:
Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

Abstract:
Arm Based on LEg blood pressures (ABLE-BP): can systolic leg blood pressure measurements predict systolic brachial blood pressure? Protocol for an individual participant data meta-analysis from the INTERPRESS-IPD Collaboration

Abstract:
Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

Abstract:
Getting evidence into clinical practice: protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure

Abstract:
Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged).

Abstract:
Validation of the Kinetik Blood Pressure Monitor-Series 1 for use in adults at home and in clinical settings, according to the 2002 European Society of Hypertension International Protocol on the validation of blood pressure devices.

Abstract:
Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis.

Abstract:
Potential benefits of dietary nitrate ingestion in healthy and clinical populations: a brief review.

Abstract:
Time-trial performance is not impaired in either competitive athletes or untrained individuals following a prolonged cognitive task.

Abstract:
Influence of dietary nitrate food forms on nitrate metabolism and blood pressure in healthy normotensive adults.

Abstract:
Influence of dietary nitrate supplementation on physiological and muscle metabolic adaptations to sprint interval training.

Abstract:
Muscle metabolic and neuromuscular determinants of fatigue during cycling in different exercise intensity domains.

Abstract:
Dietary nitrate supplementation attenuates the reduction in exercise tolerance following blood donation.

Abstract:
Dietary nitrate improves sprint performance and cognitive function during prolonged intermittent exercise.

Abstract:
The Effects of Chronic Nitrate Supplementation and the Use of Strong and Weak Antibacterial Agents on Plasma Nitrite Concentration and Exercise Blood Pressure.

Abstract:
Prevalence of Postural Hypotension in Primary, Community and Institutional Care: a Systematic Review and Meta-Analysis

Abstract:
Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

Abstract:
Arm Based on LEg blood pressures (ABLE-BP): can systolic leg blood pressure measurements predict systolic brachial blood pressure? Protocol for an individual participant data meta-analysis from the INTERPRESS-IPD Collaboration

Abstract:
Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

Abstract:
Getting evidence into clinical practice: protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure

Abstract:
Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged).

Abstract:
Validation of the Kinetik Blood Pressure Monitor-Series 1 for use in adults at home and in clinical settings, according to the 2002 European Society of Hypertension International Protocol on the validation of blood pressure devices.

Abstract:
Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis.

Abstract:
Potential benefits of dietary nitrate ingestion in healthy and clinical populations: a brief review.

Abstract:
Time-trial performance is not impaired in either competitive athletes or untrained individuals following a prolonged cognitive task.

Abstract:
Factors influencing the effects of dietary nitrate supplementation on nitric oxide biomarkers and blood pressure

Abstract:
Influence of dietary nitrate food forms on nitrate metabolism and blood pressure in healthy normotensive adults.

Abstract:
Influence of dietary nitrate supplementation on physiological and muscle metabolic adaptations to sprint interval training.

Abstract:
Muscle metabolic and neuromuscular determinants of fatigue during cycling in different exercise intensity domains.

Abstract:
Dietary nitrate supplementation attenuates the reduction in exercise tolerance following blood donation.

Abstract:
Dietary nitrate improves sprint performance and cognitive function during prolonged intermittent exercise.

Abstract:
The Effects of Chronic Nitrate Supplementation and the Use of Strong and Weak Antibacterial Agents on Plasma Nitrite Concentration and Exercise Blood Pressure.