Aortic stenosis post-COVID-19: A mathematical model on waiting lists and mortality
| Autor: | Sara Lombardo, Jonathan R. Weir-McCall, Matteo Sommacal, Ramesh Nadarajah, James H. F. Rudd, Louise Y. Sun, Mamas A. Mamas, Chris P Gale, Lars Schewe, Kieran J. Sharkey, Feryal Erhun, Ben Gibbison, Christian P Stickels, Katherine Cheema, Nick Holliman, Houyuan Jiang |
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| Přispěvatelé: | Stickels, Christian Philip [0000-0002-5286-9379], Nadarajah, Ramesh [0000-0001-9895-9356], Jiang, Houyuan [0000-0002-2466-6929], Sharkey, Kieran J [0000-0002-7210-9246], Holliman, Nick [0000-0003-4418-4908], Lombardo, Sara [0000-0003-3545-163X], Schewe, Lars [0000-0002-3778-262X], Sommacal, Matteo [0000-0003-2820-2117], Sun, Louise [0000-0003-3381-3115], Rudd, James [0000-0003-2243-3117], Mamas, Mamas [0000-0001-9241-8890], Erhun, Feryal [0000-0003-0339-7085], Apollo - University of Cambridge Repository |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Cardiovascular medicine
2019-20 coronavirus outbreak medicine.medical_specialty Waiting Lists Transcatheter aortic Coronavirus disease 2019 (COVID-19) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Waiting list mortality State Medicine RA0421 medicine Humans Aortic Valve Stenosis/surgery RD32 business.industry G900 COVID-19 General Medicine Aortic Valve Stenosis Models Theoretical medicine.disease RC666 R1 B900 Stenosis valvular heart disease Waiting list cardiology Emergency medicine Analytic solution business |
| Zdroj: | medRxiv Stickels, C P, Nadarajah, R, Gal, C P, Jiang, H, Sharkey, K J, Gibbison, B, Holliman, N, Lombardo, S, Schewe, L, Sommacal, M, Sun, L, Weir-McCall, J, Cheema, K, Rudd, J H F, Mamas, M A & Erhun, F 2022, ' Aortic stenosis post-COVID-19: A mathematical model on waiting lists and mortality ', BMJ Open, vol. 12, no. 6, e059309 . https://doi.org/10.1136/bmjopen-2021-059309 Stickels, C P, Nadarajah, R, Gale, C P, Jiang, H, Sharkey, K J, Gibbison, B, Holliman, N, Lombardo, S, Schewe, L, Sommacal, M, Sun, L, Weir-McCall, J, Cheema, K, Rudd, J H F, Mamas, M & Erhun, F 2022, ' Aortic stenosis post-COVID-19 : a mathematical model on waiting lists and mortality ', BMJ Open, vol. 12, no. 6, e059309, pp. e059309 . https://doi.org/10.1136/bmjopen-2021-059309 Stickels, C P, Nadarajah, R, Gale, C P, Jiang, H, Sharkey, K J, Gibbison, B, Holliman, N, Lombardo, S, Schewe, L, Sommacal, M, Sun, L, Weir-McCall, J, Cheema, K, Rudd, J H F, Mamas, M & Erhun, F 2022, ' Aortic stenosis post-COVID-19: a mathematical model on waiting lists and mortality ', BMJ Open, vol. 12, no. e059309, e059309 . https://doi.org/10.1136/bmjopen-2021-059309 |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2021-059309 |
| Popis: | OBJECTIVES: To provide estimates for how different treatment pathways for the management of severe aortic stenosis (AS) may affect National Health Service (NHS) England waiting list duration and associated mortality. DESIGN: We constructed a mathematical model of the excess waiting list and found the closed-form analytic solution to that model. From published data, we calculated estimates for how the strategies listed under Interventions may affect the time to clear the backlog of patients waiting for treatment and the associated waiting list mortality. SETTING: The NHS in England. PARTICIPANTS: Estimated patients with AS in England. INTERVENTIONS: (1) Increasing the capacity for the treatment of severe AS, (2) converting proportions of cases from surgery to transcatheter aortic valve implantation and (3) a combination of these two. RESULTS: In a capacitated system, clearing the backlog by returning to pre-COVID-19 capacity is not possible. A conversion rate of 50% would clear the backlog within 666 (533-848) days with 1419 (597-2189) deaths while waiting during this time. A 20% capacity increase would require 535 (434-666) days, with an associated mortality of 1172 (466-1859). A combination of converting 40% cases and increasing capacity by 20% would clear the backlog within a year (343 (281-410) days) with 784 (292-1324) deaths while awaiting treatment. CONCLUSION: A strategy change to the management of severe AS is required to reduce the NHS backlog and waiting list deaths during the post-COVID-19 'recovery' period. However, plausible adaptations will still incur a substantial wait to treatment and many hundreds dying while waiting. BG is supported by the NIHR Bristol Biomedical Research Centre at the University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust. JHFR is part-supported by the NIHR Cambridge Biomedical Research Centre, the British Heart Foundation, HEFCE, the EPSRC Cambridge Centre for Mathematics of Information in Healthcare and the Wellcome Trust. |
| Databáze: | OpenAIRE |
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