1
|
Heightman M, Prashar J, Hillman TE, Marks M, Livingston R, Ridsdale HA, Bell R, Zandi M, McNamara P, Chauhan A, Denneny E, Astin R, Purcell H, Attree E, Hishmeh L, Prescott G, Evans R, Mehta P, Brennan E, Brown JS, Porter J, Logan S, Wall E, Dehbi HM, Cone S, Banerjee A. Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325 individuals. BMJ Open Respir Res 2021; 8:8/1/e001041. [PMID: 34764200 PMCID: PMC8587466 DOI: 10.1136/bmjresp-2021-001041] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Post-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients. Methods In a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression. Results 1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6–52.8) years vs 58.3 (47.0–67.7) years and 48.5 (39.4–55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118–298) days, 69 (51–111) days and 76 (55–128) days; all p<0.0001). All groups had similar rates of onward specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were more likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). Hospitalised patients had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 716 (54.0%) individuals reported <75% optimal health (median 70%, IQR 55%–85%). Less than half of employed individuals could return to work full time at first assessment. Conclusion Post-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.
Collapse
Affiliation(s)
- Melissa Heightman
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jai Prashar
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Toby E Hillman
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael Marks
- University College London Hospitals NHS Foundation Trust, London, UK.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Robert Bell
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Michael Zandi
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Patricia McNamara
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Alisha Chauhan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma Denneny
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Ronan Astin
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Helen Purcell
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Rebecca Evans
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Puja Mehta
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Ewen Brennan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jeremy S Brown
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Joanna Porter
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Sarah Logan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma Wall
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK.,Francis Crick Institute, London, UK
| | | | - Stephen Cone
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Amitava Banerjee
- University College London Hospitals NHS Foundation Trust, London, UK .,University College London, London, UK.,Barts Health NHS Trust, London, UK
| |
Collapse
|
2
|
Alqahtani JS, Aquilina J, Bafadhel M, Bolton CE, Burgoyne T, Holmes S, King J, Loots J, McCarthy J, Quint JK, Ridsdale HA, Sapey E, Upadhyaya S, Wilkinson TMA, Hurst JR. Research priorities for exacerbations of COPD. Lancet Respir Med 2021; 9:824-826. [PMID: 34000234 DOI: 10.1016/s2213-2600(21)00227-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jaber S Alqahtani
- University College London (UCL) Respiratory, UCL, London, UK; Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Julian Aquilina
- University College London (UCL) Respiratory, UCL, London, UK
| | - Mona Bafadhel
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Charlotte E Bolton
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC) respiratory theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Steve Holmes
- Park Medical Partnership, Shepton Mallet, UK; Frimley Health NHS Foundation Trust, Windsor, UK
| | - Joanne King
- Frimley Health NHS Foundation Trust, Windsor, UK
| | - John Loots
- Patient Representative, Shepton Mallet, UK
| | | | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sheela Upadhyaya
- James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, Southampton, UK
| | | | - John R Hurst
- University College London (UCL) Respiratory, UCL, London, UK.
| |
Collapse
|
3
|
Aldhahir AM, Aldabayan YS, Alqahtani JS, Ridsdale HA, Smith C, Hurst JR, Mandal S. A double-blind randomised controlled trial of protein supplementation to enhance exercise capacity in COPD during pulmonary rehabilitation: a pilot study. ERJ Open Res 2021; 7:00077-2021. [PMID: 33816594 PMCID: PMC8005591 DOI: 10.1183/23120541.00077-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Pulmonary rehabilitation is a cost-effective management strategy in chronic obstructive pulmonary disease (COPD) which improves exercise performance and health-related quality of life. Nutritional supplementation may counter malnutrition and enhance pulmonary rehabilitation outcomes but rigorous evidence is absent. We aimed to investigate the effect of high-protein supplementation (Fortisip Compact Protein (FCP)) during pulmonary rehabilitation on exercise capacity. Methods This was a double-blind randomised controlled trial comparing FCP (intervention) with PreOp (a carbohydrate control supplement) in COPD patients participating in a pulmonary rehabilitation programme. Participants consumed the supplement twice a day during pulmonary rehabilitation and attended twice-weekly pulmonary rehabilitation sessions, with pre- and post-pulmonary rehabilitation measurements, including the incremental shuttle walk test (ISWT) distance at 6 weeks as the primary outcome. Participants’ experience using supplements was assessed. Results 68 patients were recruited (intervention n=36 and control n=32). The trial was stopped early due to the COVID-19 pandemic. Although statistical significance was not reached, there was the suggestion of a clinically meaningful difference in the ISWT distance at 6 weeks favouring the intervention group (intervention 342±149 m (n=22) versus control 305±148 m (n=22); p=0.1). Individuals who achieved an improvement in the ISWT had a larger mid-thigh circumference at baseline (responders 62±4 cm versus nonresponders 55±6 cm; p=0.006). 79% of the patients were satisfied with the taste and 43% would continue taking the FCP. Conclusions Although the data did not demonstrate a statistically significant difference in the ISWT, high-protein supplementation in COPD during pulmonary rehabilitation may result in a clinically meaningful improvement in exercise capacity and was acceptable to patients. Large, adequately powered studies are justified. High-protein supplementation combined with pulmonary rehabilitation in COPD did not statistically improve exercise capacity but may be associated with a clinically meaningful improvement. Larger trials are needed to confirm this.https://bit.ly/3tMtX9O
Collapse
Affiliation(s)
- Abdulelah M Aldhahir
- UCL Respiratory, Royal Free Campus, University College London, London, UK.,Respiratory Therapy Dept, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Yousef S Aldabayan
- UCL Respiratory, Royal Free Campus, University College London, London, UK.,Respiratory Care Dept, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Jaber S Alqahtani
- UCL Respiratory, Royal Free Campus, University College London, London, UK.,Dept of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | | | - Colette Smith
- Research Dept of Infection and Population Health, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, Royal Free Campus, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK.,These authors contributed equally to this work
| | - Swapna Mandal
- UCL Respiratory, Royal Free Campus, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK.,These authors contributed equally to this work
| |
Collapse
|
4
|
Yakutcan U, Demir E, Hurst JR, Taylor PC, Ridsdale HA. Operational Modeling with Health Economics to Support Decision Making for COPD Patients. Health Serv Res 2021; 56:1271-1280. [PMID: 33754333 DOI: 10.1111/1475-6773.13652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To assess the impact of interventions for improving the management of chronic obstructive pulmonary disease (COPD), specifically increased use of pulmonary rehabilitation (PR) on patient outcomes and cost-benefit analysis. DATA SOURCES We used the national Hospital Episode Statistics (HES) datasets in England, local data and experts from the hospital setting, National Prices and National Tariffs, reports and the literature around the effectiveness of PR programs. STUDY DESIGN The COPD pathway was modeled using discrete event simulation (DES) to capture the patient pathway to an adequate level of detail as well as randomness in the real world. DES was further enhanced by the integration of a health economic model to calculate the net benefit and cost of treating COPD patients based on key sets of interventions. DATA COLLECTION/EXTRACTION METHODS A total of 150 input parameters and 75 distributions were established to power the model using the HES dataset, outpatient activity data from the hospital and community services, and the literature. PRINCIPAL FINDINGS The simulation model showed that increasing referral to PR (by 10%, 20%, or 30%) would be cost-effective (with a benefit-cost ratio of 5.81, 5.95, and 5.91, respectively) by having a positive impact on patient outcomes and operational metrics. Number of deaths, admissions, and bed days decreased (ie, by 3.56 patients, 4.90 admissions, and 137.31 bed days for a 30% increase in PR referrals) as well as quality of life increased (ie, by 5.53 QALY among 1540 patients for the 30% increase). CONCLUSIONS No operational model, either statistical or simulation, has previously been developed to capture the COPD patient pathway within a hospital setting. To date, no model has investigated the impact of PR on COPD services, such as operations, key performance, patient outcomes, and cost-benefit analysis. The study will support policies around extending availability of PR as a major intervention.
Collapse
Affiliation(s)
- Usame Yakutcan
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - Eren Demir
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Paul C Taylor
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - Heidi A Ridsdale
- Camden COPD and Home Oxygen Service, Central and North West London NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Aldabayan YS, Ridsdale HA, Alrajeh AM, Aldhahir AM, Lemson A, Alqahtani JS, Brown JS, Hurst JR. Pulmonary rehabilitation, physical activity and aortic stiffness in COPD. Respir Res 2019; 20:166. [PMID: 31340825 PMCID: PMC6657099 DOI: 10.1186/s12931-019-1135-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiovascular risk, and cardiovascular disease is a major cause of death in COPD. The current literature indicates that changes in cardiovascular risk during pulmonary rehabilitation (assessed using aortic stiffness) are heterogeneous suggesting that there may be sub-groups of patients who do and do not benefit. Objectives To investigate the characteristics of COPD patients who do and do not experience aortic stiffness reduction during pulmonary rehabilitation, examine how changes relate to physical activity and exercise capacity, and assess whether changes in aortic stiffness are maintained at 6 weeks following rehabilitation. Methods We prospectively measured arterial stiffness (aortic pulse-wave velocity), exercise capacity (Incremental Shuttle Walk Test) and physical activity (daily step count) in 92 COPD patients who started a six week pulmonary rehabilitation programme, 54 of whom completed rehabilitation, and 29 of whom were re-assessed six weeks later. Results Whilst on average there was no influence of pulmonary rehabilitation on aortic stiffness (pre- vs. post pulse-wave velocity 11.3 vs. 11.1 m/s p = 0.34), 56% patients responded with a significant reduction in aortic stiffness. Change in aortic stiffness (absolute and/or percentage) during rehabilitation was associated with both increased physical activity (rho = − 0.30, p = 0.042) and change in exercise capacity (rho = − 0.32, p = 0.02), but in multivariable analysis most closely with physical activity. 92% of the responders who attended maintained this response six weeks later. Conclusion Elevated aortic stiffness in COPD is potentially modifiable in a subgroup of patients during pulmonary rehabilitation and is associated with increased physical activity. Trial registration ClinicalTrials.gov Identifier: NCT03003208. Registered 26/12/ 2016.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - John R Hurst
- UCL Respiratory, University College London, London, UK.
| |
Collapse
|
6
|
Affiliation(s)
- Heidi A Ridsdale
- Central and North West London NHS Foundation Trust, London, UK.,The Camden COPD Service
| | - John R Hurst
- The Camden COPD Service.,UCL Respiratory, UCL Medical School, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| |
Collapse
|