Hannah R Whittaker1, Olivia Connell2, Jennifer Campbell3, Amany F Elbehairy4, Nicholas S Hopkinson5, Jennifer K Quint5. 1. National Heart and Lung Institute, Imperial College London, London, England. Electronic address: h.whittaker@imperial.ac.uk. 2. Barts and the London School of Medicine and Dentistry, London, England. 3. Clinical Practice Research Datalink, the Medicines and Healthcare Products Regulatory Agency, London, England. 4. National Heart and Lung Institute, Imperial College London, London, England; Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt. 5. National Heart and Lung Institute, Imperial College London, London, England.
Abstract
BACKGROUND: Although lung volume reduction surgery (LVRS) improves survival in appropriately selected patients with COPD, few procedures are performed. The National Institute for Health and Care Excellence has recommended a more systematic approach to identifying potential candidates. We investigated LVRS referrals from a UK primary care population and aimed to establish an accurate estimate of eligible patients and determine a strategy for identifying potential candidates systematically. METHODS: Clinical Practice Research Datalink GOLD (a primary care database) and the linked Hospital Episode Statistics inpatient and Diagnostic Imaging Dataset were used. Patients with COPD who had undergone LVRS, patients who met basic eligibility criteria for further screening for LVRS, and patients meeting a more stringent eligibility criteria were identified from April 2012 to September 2015. Thoracic CT scan, pulmonary rehabilitation status, referral to respiratory outpatient clinics, and acute exacerbation of COPD requiring hospitalization were compared between actual LVRS recipients and potentially eligible patients. RESULTS: Among the 73,697 patients with COPD included, 36 (0.05%) received LVRS, 5,984 (8.1%) met basic eligibility criteria, and 159 (0.2%) met more stringent eligibility criteria. LVRS recipients were younger (mean age ± SD, 64 ± 9.2 years) than the stringently eligible patients (mean age ± SD, 69 ± 8.9 years; P = .01). Few patients meeting stringent eligibility criteria (6.9%) had a CT scan of the thorax in the preceding 3 years or had been referred for assessment in secondary care. CONCLUSIONS: A substantial unmet need exists among patients with COPD who could potentially benefit from a lung volume reduction procedure but who are not being investigated or referred to consider this possibility.
BACKGROUND: Although lung volume reduction surgery (LVRS) improves survival in appropriately selected patients with COPD, few procedures are performed. The National Institute for Health and Care Excellence has recommended a more systematic approach to identifying potential candidates. We investigated LVRS referrals from a UK primary care population and aimed to establish an accurate estimate of eligible patients and determine a strategy for identifying potential candidates systematically. METHODS: Clinical Practice Research Datalink GOLD (a primary care database) and the linked Hospital Episode Statistics inpatient and Diagnostic Imaging Dataset were used. Patients with COPD who had undergone LVRS, patients who met basic eligibility criteria for further screening for LVRS, and patients meeting a more stringent eligibility criteria were identified from April 2012 to September 2015. Thoracic CT scan, pulmonary rehabilitation status, referral to respiratory outpatient clinics, and acute exacerbation of COPD requiring hospitalization were compared between actual LVRS recipients and potentially eligible patients. RESULTS: Among the 73,697 patients with COPD included, 36 (0.05%) received LVRS, 5,984 (8.1%) met basic eligibility criteria, and 159 (0.2%) met more stringent eligibility criteria. LVRS recipients were younger (mean age ± SD, 64 ± 9.2 years) than the stringently eligible patients (mean age ± SD, 69 ± 8.9 years; P = .01). Few patients meeting stringent eligibility criteria (6.9%) had a CT scan of the thorax in the preceding 3 years or had been referred for assessment in secondary care. CONCLUSIONS: A substantial unmet need exists among patients with COPD who could potentially benefit from a lung volume reduction procedure but who are not being investigated or referred to consider this possibility.
Authors: Peter Alter; Jan Orszag; Christina Kellerer; Kathrin Kahnert; Tim Speicher; Henrik Watz; Robert Bals; Tobias Welte; Claus F Vogelmeier; Rudolf A Jörres Journal: ERJ Open Res Date: 2020-07-27
Authors: Sara C Buttery; Adam Lewis; Samuel V Kemp; Winston Banya; Jennifer K Quint; Michael C Steiner; Nicholas S Hopkinson Journal: BMJ Open Date: 2020-11-27 Impact factor: 2.692