Breathless and awaiting diagnosis in UK lockdown for COVID-19…We’re stuck

Doe, Gillian; Chantrell, Stacey; Williams, Marie; Steiner, Michael; Armstrong, Natalie; Hutchinson, Ann; Evans, Rachael A.

doi:10.1038/s41533-021-00232-0

Cited by 6 publications

(8 citation statements)

References 16 publications

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“…Fewer new diagnoses of asthma might also have been because breathlessness or wheeze was attributed to other causes, such as sequelae after acute covid-19 infection, or to social distancing, and lockdown measures, resulting in less transmission of other respiratory viruses and therefore asthma flares; changes in healthcare seeking behaviour in people with chronic breathing problems might also have been a factor. 30 Because of social distancing measures, outpatient and primary care clinical reviews changed from face-to-face to remote access, and so chest examinations were often not possible. Similarly, individuals with symptoms such as cough were advised not to attend primary care clinics during the pandemic, which could partially explain the decreased rates of recorded cough and sore throat after covid-19 compared with rates 12 months before infection.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

GP consultation rates for sequelae after acute covid-19 in patients managed in the community or hospital in the UK: population based study

Whittaker

Gulea

Koteci

et al. 2021

BMJ

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ObjectivesTo describe the rates for consulting a general practitioner (GP) for sequelae after acute covid-19 in patients admitted to hospital with covid-19 and those managed in the community, and to determine how the rates change over time for patients in the community and after vaccination for covid-19.DesignPopulation based study.Setting1392 general practices in England contributing to the Clinical Practice Research Datalink Aurum database.Participants456 002 patients with a diagnosis of covid-19 between 1 August 2020 and 14 February 2021 (44.7% men; median age 61 years), admitted to hospital within two weeks of diagnosis or managed in the community, and followed-up for a maximum of 9.2 months. A negative control group included individuals without covid-19 (n=38 511) and patients with influenza before the pandemic (n=21 803).Main outcome measuresComparison of rates for consulting a GP for new symptoms, diseases, prescriptions, and healthcare use in individuals admitted to hospital and those managed in the community, separately, before and after covid-19 infection, using Cox regression and negative binomial regression for healthcare use. The analysis was repeated for the negative control and influenza cohorts. In individuals in the community, outcomes were also described over time after a diagnosis of covid-19, and compared before and after vaccination for individuals who were symptomatic after covid-19 infection, using negative binomial regression.ResultsRelative to the negative control and influenza cohorts, patients in the community (n=437 943) had significantly higher GP consultation rates for multiple sequelae, and the most common were loss of smell or taste, or both (adjusted hazard ratio 5.28, 95% confidence interval 3.89 to 7.17, P<0.001); venous thromboembolism (3.35, 2.87 to 3.91, P<0.001); lung fibrosis (2.41, 1.37 to 4.25, P=0.002), and muscle pain (1.89, 1.63 to 2.20, P<0.001); and also for healthcare use after a diagnosis of covid-19 compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients in the community were joint pain (2.5%), anxiety (1.2%), and prescriptions for non-steroidal anti-inflammatory drugs (1.2%). Patients admitted to hospital (n=18 059) also had significantly higher GP consultation rates for multiple sequelae, most commonly for venous thromboembolism (16.21, 11.28 to 23.31, P<0.001), nausea (4.64, 2.24 to 9.21, P<0.001), prescriptions for paracetamol (3.68, 2.86 to 4.74, P<0.001), renal failure (3.42, 2.67 to 4.38, P<0.001), and healthcare use after a covid-19 diagnosis compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients admitted to hospital were venous thromboembolism (3.5%), joint pain (2.7%), and breathlessness (2.8%). In patients in the community, anxiety and depression, abdominal pain, diarrhoea, general pain, nausea, chest tightness, and tinnitus persisted throughout follow-up. GP consultation rates were reduced for all symptoms, prescriptions, and healthcare use, except for neuropathic pain, cognitive impairment, strong opiates, and paracetamol use in patients in the community after the first vaccination dose for covid-19 relative to before vaccination. GP consultation rates were also reduced for ischaemic heart disease, asthma, and gastro-oesophageal disease.ConclusionsGP consultation rates for sequelae after acute covid-19 infection differed between patients with covid-19 who were admitted to hospital and those managed in the community. For individuals in the community, rates of some sequelae decreased over time but those for others, such as anxiety and depression, persisted. Rates of some outcomes decreased after vaccination in this group.

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Section: Discussionmentioning

confidence: 99%

“…Alternatively, our findings could be because influenza is less commonly associated with multisystem complications, such as venous thromboembolism, than covid-19, as has been shown in previous studies. 30 …”

Section: Discussionmentioning

confidence: 99%

GP consultation rates for sequelae after acute covid-19 in patients managed in the community or hospital in the UK: population based study

Whittaker

Gulea

Koteci

et al. 2021

BMJ

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“…An incremental approach to investigation to rule out individual diagnoses was described by clinicians, which aligns with disease-specific guidelines which promote excluding a particular diagnosis, rather than a holistic approach to find all causes of a symptom. Following an incremental approach could be appropriate if timely investigations and multiple reviews were possible; however, this is commonly not achievable, would use more clinician time, and has been further exacerbated by the COVID-19 pandemic causing delays in healthcare (35). A symptom-based approach also enables identification of multiple causes of breathlessness which is important and relevant as multi-morbidity prevalence rises and is a major problem for healthcare systems (36).…”

Section: Discussionmentioning

confidence: 99%

Investigating a structured diagnostic approach for chronic breathlessness in primary care: a mixed-methods feasibility cluster Randomised Controlled Trial

Doe,

Clanchy,

Wathall

et al. 2024

Preprint

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BackgroundThere is need to reduce delays to diagnosis for chronic breathlessness to improve patient outcomes.ObjectiveTo conduct a mixed-methods feasibility trial of a larger cluster Randomised Controlled Trial (cRCT) investigating a structured symptom-based diagnostic approach versus usual care for chronic breathlessness in primary careMethodsTen general practitioner (GP) practices were cluster randomised to a structured diagnostic approach for chronic breathlessness, including early investigations (intervention), or usual care. Adults over 40 years old at participating practices were eligible if presenting with chronic breathlessness, without existing diagnosis. The primary feasibility outcomes were participant recruitment and retention rate at one year. Secondary outcomes included number of investigations at three months, and number of diagnoses and patient reported outcome measures (PROMs) at one year.ResultsRecruitment rate was 22% (48/220): 65% female, mean (SD) age 66 (11) years, BMI 31.2kg/m2(6.5), median (IQR) MRC dyspnoea 2 (2–3). Retention rate was 85% (41/48). At three months, the intervention group had a median (IQR) of 8 (7–9) investigations compared with 5 (3–6) investigations in usual care. 11/25 (44%) patients in the intervention group had a coded diagnosis for breathlessness at 12 months compared with 6/23 (26%) in usual care. Potential improvements in symptom burden and quality of life were observed in the intervention group.ConclusionsA cRCT investigating a symptom-based diagnostic approach for chronic breathlessness is feasible in primary care showing potential for timely investigations and diagnoses, with PROMs indicating patient-level benefit. A further refined fully powered cRCT with health economic analysis is needed.What is already known on this topicThere are known delays to diagnosis for patients with long-term conditions commonly presenting with breathlessness. A structured symptom-based approach for breathlessness with early investigations may reduce delays and improve patient outcomes, but the clinical and cost effectiveness of such a pathway is unknown.What this study addsWe demonstrated that a future trial investigating a symptom-based structured diagnostic approach for breathlessness is feasible. Our results show participants in the intervention group had more investigations and earlier diagnoses alongside potential to reduce symptom burden.How this study might affect research, practice or policyA symptom-based approach for breathlessness in primary care has the potential to reduce delays to diagnosis, improve outcomes for patients, and appears acceptable to patients and clinicians; refinement of the pathway and a fully powered cRCT with health economic modelling is needed.

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“…Thirdly, depending on the severity of the pandemic, sometimes it has been difficult to access primary care and specialized doctors. In their study, Doe and cols described an increase in the time lapse for diagnosis in patients complaining of breathlessness (12). Chest physicians changed their usual clinical activities, being actively involved in the management of patients with respiratory failure and SARS-CoV-2 pneumonia, and several visits end exams were postponed or cancelled.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on Diagnosis of Respiratory Diseases in the Northern Metropolitan Area in Barcelona (Spain)

Olivé¹,

Stojanović²,

Rivera³

et al. 2022

Preprint

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Objective: Several authors have analyzed the impact of the pandemic on the incidence rates of different conditions. Our aim was to analyze the impact of the COVID-19 pandemic on primary care new diagnoses of respiratory diseases. Methods: This was an observational retrospective study performed to describe the impact of COVID-19 pandemic on primary care new diagnosis of respiratory diseases other than lung cancer. Incidence rate ratio between pre-pandemic and pandemic period was calculated. Results: We found an decrease in the incidence of respiratory conditions (IRR 0.65) during the pandemic period. When we compared the different groups of diseases according to ICD-10, we found a significant decrease in the number of new cases during the pandemic period, except in the case of pulmonary tuberculosis, abscesses or necrosis of the lungs and other respiratory complications. Instead, we found increases in new diagnoses of flu and pneumonia (IRR 2.17) and respiratory interstitial diseases (IRR 1.41). Conclusion: There has been a decrease in new diagnosis of most respiratory diseases during the COVID-19 pandemic. The real clinical impact of this situation is still unknown. Large-scale real-life studies will make it possible to evaluate the long-term true impact of COVID-19 pandemic on the respiratory diseases management.

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Breathless and awaiting diagnosis in UK lockdown for COVID-19…We’re stuck

Cited by 6 publications

References 16 publications

GP consultation rates for sequelae after acute covid-19 in patients managed in the community or hospital in the UK: population based study

GP consultation rates for sequelae after acute covid-19 in patients managed in the community or hospital in the UK: population based study

Investigating a structured diagnostic approach for chronic breathlessness in primary care: a mixed-methods feasibility cluster Randomised Controlled Trial

Impact of COVID-19 on Diagnosis of Respiratory Diseases in the Northern Metropolitan Area in Barcelona (Spain)

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