Clinical Improvement Seen in Study of 1st Year of COVID-19 Pandemic
Better lung function, BMI in CF patients came after increased telehealth use
Twelve months into the COVID-19 pandemic, Australian adults and children with cystic fibrosis (CF) showed improved lung function and body mass index (BMI), as well as a lower hospitalization rate, a study reports.
“Differing models of care and major changes in community interactions both have the potential to influence clinical outcomes in chronic disease,” the researchers wrote. “This study has demonstrated that the COVID-19 pandemic forced a change in the CF model of clinical care delivery.”
The study, “Clinical outcomes of adults and children with cystic fibrosis during the COVID-19 pandemic,” was published in Journal of Cystic Fibrosis.
Monitoring CF patients typically involves regular face-to-face clinical visits, both in inpatient and outpatient settings. However, it can also be provided by telehealth, through video or a phone call.
Telehealth benefits include improving access to specialty care, early detection of clinical alterations, and a lower risk of cross-infection.
“However, there are concerns from CF clinicians about widespread use of telehealth, including ability to complete comprehensive patient assessment and ensuring equitable access,” the researchers wrote.
In Australia, about 30% of people live outside major cities. As such, the COVID-19 pandemic required increasing use of telehealth as a replacement for clinical visits, due to travel restrictions and limited access to healthcare facilities.
Early feedback on telehealth during the pandemic indicated that CF patients were highly satisfied, showing stability in lung function and decreased pulmonary exacerbations (times when symptoms get worse, usually associated with infections).
The study and its results
Aiming to report on the impact on clinical outcomes at a national level 12 months after the onset of the pandemic, a research team in Australia used the Australian Cystic Fibrosis Data Registry, which has data from approximately 95% of adults and children with CF.
In total, data were available for 3,662 patients — 1,930 males and 1,732 females with a mean age of 20.2 years, ranging from 0 to 82. March 16, 2020, was chosen as the start date to assess outcomes, as that was when the Australian government limited the number of people allowed to gather publicly and when funding was approved to encourage telehealth evaluations.
Lung function — determined by the percent predicted forced expiratory volume in one second (ppFEV1), which is how much air is forced from the lungs in one second — and BMI, a measure of body fat, were compared 24 months before versus 12 months after the pandemic onset.
Other parameters, including the number of hospitalizations and virtual consultations, were compared 12 months before versus 12 months after the start date.
The researchers found ppFEV1 to be improved in adults (mean study entry value of 66.1%) and in children 5 to 12 (92.2%) after 12 months of COVID-19. In both, ppFEV1 went from a mean annual decline before study start of 0.38% and 0.46%, respectively, to an improvement in lung function of 1.29% in adults and 0.97% in children.
In children 12 to 17, whose mean study entry ppFEV1 was 81.7%, the annual ppFEV1 slope improved further from 0.99% to 3.78%.
As for BMI, patients 17 and older showed a significant increase in one year — 0.03 kg per square meter (kg/m2) vs. 0.30 kg/m2, with a mean entry BMI of 20.1 kg/m2. In younger patients, BMI (measured as a Z-score, the difference between a CF child’s BMI at a certain age to healthy growth reference values) was already improving before the pandemic and continued after — 0.05 kg/m2 vs. 0.12 kg/m2.
In addition, the number of hospitalizations one year after the start date dropped significantly (2,656 vs. 1,957), including a 26% reduction in those requiring into-the-vein antibiotics.
Before the pandemic, 92% of outpatient CF monitoring was done face to face, with 8% through telehealth. But one year into the pandemic in Australia, in-person visits decreased to 53%, with virtual consultations increasing to 47%.
Overall, “in the 12-months following the onset of the COVID-19 pandemic, there was an improvement in the clinical outcomes of people with CF when compared to the pre-pandemic period,” the research team wrote.
European studies also showed an increase in lung function. However, this was shown after two to three months of pandemic-related lockdown and using single lung-function values, while the Australian study used national data from a longer period of time.
Despite the observed benefits of COVID-19 restrictions and telehealth in CF, “due to the retrospective design of the study, no conclusions are able to be drawn regarding the cause of the improved clinical outcomes,” the researchers concluded. A retrospective study is one that uses data compiled from the past.
“Multiple factors, including reduced [community] interaction and reduced exposure to respiratory viruses, as well as a change to a more remote model of care may have contributed to the findings. However … causation is unable to be determined,” the scientists concluded.