CONNECT-AF is establishing a secure, federated research network across multiple Trusted Research Environments (TREs), co-designing a robust approach to depict Atrial Fibrillation (AF) care pathways and evaluating national trends and clinical outcomes without moving patient-level data.
Regional inequalities in AF care and outcomes remain difficult to identify and address consistently across the UK because health data are held in separate TREs. Each TRE has distinct data structures, access processes and governance requirements, creating silos that limit analysis of AF care pathways and regional variation. CONNECT-AF (Cross-TRE Network for Evaluating Clinical Outcomes and National Trends in Embolic Complications of Atrial Fibrillation) is addressing this challenge by establishing a federated research network and assessing the readiness of three pioneering TREs for secure analytics, supporting more equitable care across the UK.
By establishing a patient-centred federated research network, CONNECT-AF will assess the readiness of UK TREs and address barriers to analysing health data securely and consistently across different regions. This will generate more representative and reliable evidence to understand and improve distinct AF care pathways and outcomes, while ensuring that confidential patient-level data remain protected within each secure environment.
This work is led by Swansea University in partnership with the University of Cambridge PACE, SAIL Databank, Dementias Platform UK, the Eastern Secure Data Environment, Health Innovation East and the UK Secure Research Platform, with patients and public contributors as key delivery partners.
CONNECT-AF is assessing the readiness of all three partner TREs for adoption of federated analytics to enable approved, standardised analyses to be executed securely across multiple TREs without moving patient-level data. Data remains at its source, while the Five Safes Task Execution Service (5S-TES), sends analysis to the data and receives safe aggregated outputs. Combined with a robust data harmonisation stream, this supports consistent cohort definitions and analyses across participating TREs, helping assess readiness for federation and generate comparable evidence on AF care and outcomes.
What CONNECT-AF aims to achieve
By the end of the project, CONNECT-AF aims to establish and evaluate a secure, reproducible federated approach to analysing AF data across regions without moving patient-level data. Our work is organised across four parallel workstreams, each with a clear end goal:
- Harmonising data – Aligning AF cohorts, outcomes and data structures across the three TREs to support consistent and comparable analyses.
- Advancing federation – Assessing the technical, data and governance readiness of each TRE for implementing and testing the Five Safes Task Execution Service (5S-TES).
- Building robust evidence – Comparing AF care pathways and outcomes over time and across regions and demonstrating that diverse data can be analysed consistently and reproducibly across TREs, generating comparable evidence without sharing patient-level data.
- Working with the public – co-developing the approach with AF patients and carers and Patient and Public Involvement and Engagement (PPIE) leads, translating complex research protocols and federated analytics into accessible and meaningful resources for all.
Progress so far
In the last six months, the team has:
- Established a robust protocol for curating base data into harmonised AF cohorts within each TRE, with a manuscript prepared for peer-review submission.
- Developed a shared seven-state multi-state modelling approach to estimate transitions from AF to stroke, dementia and other outcomes.
- Working with public contributors and leads, we translated the research protocol into accessible materials and began co-developing resources explaining CONNECT-AF’s governance framework and federated approach across diverse datasets and regions.
- Partners began evaluating the implementation of 5S-TES within their TREs and worked together to agree on a coordinated pathway for cross-TRE delivery.
Our focus over the next phase, will be dedicated to completion of cohort harmonisation, implementation of analysis, and run of the shared analytical pipeline across all three TREs. We will run public workshops, evaluate federation readiness, produce comparable findings on AF care and outcomes, and share practical recommendations and accessible outputs with researchers, TREs, patients and the public.
Relevance to TREvolution
CONNECT-AF supports TREvolution by testing how 5S-TES, harmonised data and reproducible pipelines can enable generation of highly relevant clinical insights for AF patients. It will deliver practical evidence on federation readiness, reusable methods and accessible public resources demonstrating how federated analytics can improve understanding of patient care pathways without moving patient-level data.
About the DARE UK Research Exemplars
The DARE UK Research Exemplars are short, impactful research projects demonstrating how emerging Trusted Research Environment (TRE) capabilities can support real-world sensitive data research across the UK. Working across multiple TREs and research domains, these projects bring together researchers, TRE operators, public contributors and other partners to apply and evaluate innovations developed through TREvolution. Their role is to test new approaches in live research settings, generating practical evidence on what works well, what challenges remain, and how sensitive data research can be strengthened for the public good.
