Patient Recovery From Heart Surgery During the Covid-19 Pandemic (CardiacCovid)

An Observational Cohort Study to Explore Patient Outcome From Heart Surgery During the Covid-19 Pandemic (CardiacCovid)

This study will describe and explore the recovery process of patients undergoing cardiac surgery during the covid-19 pandemic. This will include mortality, morbidity, health-related quality of life, event-specific distress and depression.

Study Overview

• Status: Completed
• Conditions: COVID; Cardiac Surgery
• Intervention / Treatment: Other: Cardiac surgery

Detailed Description

The overall aim of this study is to describe and explore the recovery process of patients undergoing cardiac surgery during the covid-19 pandemic. This will include mortality, morbidity, health-related quality of life, event-specific distress and depression.

All adult patients having cardiac surgery during the pandemic at St Bartholomew's Hospital will be approached to join this study. As of the end of March this is this is approximately 20 operations a week. Questionnaires will be administered at five time points alongside a review of clinical notes.

Appropriate descriptive and summative statistics will be used to analyse outcomes. If sample size is adequate, possible associations/effect of the impact of the covid-19 pandemic on each of the recovery parameters included in the study will be determined. The differences in outcomes between those with and without covid-19 may also be analysed if the sample size is adequate. Bias and loss to follow-up in observational cohort studies has been considered.

• Study Type: Observational
• Enrollment (Actual): 253

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, EC1A 7DN
    • St Bartholomew'S Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 120 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Adult patients undergoing cardiac surgery during the COVID-19 pandemic

Description

Inclusion Criteria:

• Undergoing cardiac surgery during the Covid-19 pandemic (end date as yet unknown but inferred when elective surgery is reinstated)
• Discharge from hospital where operation was performed is being planned
• Able and willing to give informed consent

Exclusion Criteria:

• Unable or unwilling to give written informed consent. This includes patients who are being transferred to another hospital and are considered too vulnerable or unwell to be approached (based on clinical judgement of the clinical care team)
• Unable or unwilling to give and/or complete the questionnaires
• Inability to understand written and/or verbal English

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Cardiac surgery patients - lockdown 1; Cohort 1 (lockdown 1): Patients undergoing adult cardiac surgery during the Covid-19 pandemic	Other: Cardiac surgery; Cardiac surgery during the COVID-19 pandemic
Cardiac surgery patients - lockdown 2; Cohort 2 (lockdown 2): Patients undergoing adult cardiac surgery during the Covid-19 pandemic	Other: Cardiac surgery; Cardiac surgery during the COVID-19 pandemic
Cardiac surgery patients - lockdown 3; Cohort 3 (lockdown 3): Patients undergoing adult cardiac surgery during the Covid-19 pandemic	Other: Cardiac surgery; Cardiac surgery during the COVID-19 pandemic

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Impact of Events scores	The revised Impact of Events revised version (IES-R) questionnaire (Weiss and Marmar, 1997) is widely used as a measure of event-specific distress and measures distress experienced by serious life changes/events. It has been commonly used to assess persons with posttraumatic stress disorder (PTSD). It is an 22 item self-report scale where is item is reported on a five point likert scale from 0 (not at all) to 4 (extremely) with respect to how distressing each item has been during the past week. Scale scores are formed for the three subscales, which reflect intrusion (8 items: 1, 2, 3, 6, 9, 14, 16, 20), avoidance (8 items: 5,7,8,11,12,13,17,22), and hyperarousal (6 items: 4,10,15.18.19.21). A cut-off of 26 and above has been suggested for a clinically significant reaction to a psychological trauma, although the IES alone does not diagnose PTSD or reflect a person's ability to function. Metric for summarising data: t-test	Baseline, 1 week after discharge, 6 weeks (+/- 2 weeks) post surgery, 6 months (+/- 2 weeks) post surgery, 1 year (+/- 2 weeks) post surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Survival	Death or survival after cardiac surgery	Up to 1 year post surgery
Morbidity	patient completion of a log sheet documenting all 'visits' (including calls to NHS 111, face-to-face or virtual visits) to the emergency department, hospital admissions and visits to the general practitioner on a standardised proforma for the duration of the study	Up to 1 year post surgery
Change in Health-related quality of life scores	Health-related quality of life will be measured using the EQ5D-5L questionnaire. The EQ5D is a standardised, simple generic measure of health well, which is received by patients (Kim et al., 2005). It consists of five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) each with five levels of health response and a visual analogue scale (VAS) ranging from 0-100 (0 being the worst possible health imaginable and 100 being the best possible health imaginable). Metric for summarising data: t-test	Baseline, 1 week after discharge, 6 weeks (+/- 2 weeks) post surgery, 6 months (+/- 2 weeks) post surgery, 1 year (+/- 2 weeks) post surgery
Change in Depression scores	Depression will be measured using the Centre for Epidemiologic Studies Depression Scale (CES-D). The CES-D is a 20-item self-report adult instrument designed to measure common symptoms of depression that have occurred over the past week, such as poor appetite, hopelessness, pessimism, and fatigue. All questions are answered on a scale of 0-3, with 0 indicating no symptom presence and with 3 representing symptoms "most or all of the time." CES-D scores range from 0 to 60 with higher scores indicating more severe depressive symptoms. A score of 16 or higher identifies subjects with clinically meaningful depression. Metric for summarising data: t-test	Baseline, 1 week after discharge, 6 weeks (+/- 2 weeks) post surgery, 6 months (+/- 2 weeks) post surgery, 1 year (+/- 2 weeks) post surgery

Collaborators and Investigators

• Sponsor: Barts & The London NHS Trust
• Collaborators: Queen Mary University of London
• Investigators: Principal Investigator: Julie Sanders, PhD, St. Bartholomew's Hospital

Publications and helpful links

General Publications

• Sanders J, Bueser T, Beaumont E, Dodd M, Murray SE, Owens G, Berry A, Hyde E, Clayton T, Oo AY. THE IMPACT OF THE COVID-19 PANDEMIC ON RECOVERY FROM CARDIAC SURGERY: 1 YEAR OUTCOMES. Eur J Cardiovasc Nurs. 2022 Sep 13:zvac083. doi: 10.1093/eurjcn/zvac083. Online ahead of print.

Study record dates

Study Major Dates

• Study Start (Actual): April 18, 2020
• Primary Completion (Actual): March 3, 2022
• Study Completion (Actual): March 3, 2022

Study Registration Dates

• First Submitted: April 24, 2020
• First Submitted That Met QC Criteria: April 27, 2020
• First Posted (Actual): April 28, 2020

Study Record Updates

• Last Update Posted (Actual): October 13, 2022
• Last Update Submitted That Met QC Criteria: October 11, 2022
• Last Verified: October 1, 2021

More Information

Terms related to this study

• Keywords: cardiac surgery; COVID; patient reported outcomes
• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19
• Other Study ID Numbers: 132127

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No