BackgroundPatients with COVID-19 are thought to be at higher risk of cardiometabolic and pulmonary complications, but quantification of that risk is limited. We aimed to describe the overall burden of these complications in survivors of severe COVID-19.MethodsWorking on behalf of NHS England we used data from the OpenSAFELY platform linking primary care records to death certificate and hospital data. We constructed two cohorts: a COVID-19 cohort consisting of patients discharged following hospitalisation with COVID-19, and a comparison population of patients discharged following hospitalisation with pneumonia in 2019. Outcomes included DVT, PE, ischaemic stroke, MI, heart failure, AKI and new type 2 diabetes diagnosis. Outcome rates from hospital discharge were measured in each cohort, stratified by patient demographics and 30-day period. We fitted Cox regression models to estimate crude and age/sex adjusted hazard ratios comparing outcome rates between the two cohorts.ResultsAmongst the population of 31,569 patients discharged following hospitalisation with COVID-19, the highest rates were observed for heart failure (199.3; 95% CI: 191.8 - 207.1) and AKI (154.5; 95% CI: 147.9 - 161.4). Rates of DVT, heart failure, ischaemic stroke, MI, PE and diabetes were high over the four months post discharge, especially in the first month. Patterns were broadly similar to those seen in patients discharged with pneumonia but somewhat higher in the COVID-19 population for stroke (adj-HR 1.78; 95% CI: 1.53 - 2.08), PE (adj-HR 1.38; 95% CI: 1.21 - 1.58), MI (adj-HR 1.46; 95% CI: 1.20 - 1.76), AKI (adj-HR 1.27; 95% CI: 1.19 - 1.36) and T2DM (adj-HR 1.28; 95% CI: 1.08 - 1.50).ConclusionsIn this descriptive study of survivors of severe COVID-19, rates of the measured outcomes are at least as high, though in some cases slightly higher, than in patients discharged after hospitalisation with pneumonia. Further work is needed to identify what characteristics of COVID-19 patients put them at highest risk of adverse events.
A case of late-onset life threatening angioedema because of upper airway obstruction after long term use of angiotensin-converting enzyme inhibitor was reported. The clinical presentation, pitfalls in diagnosis, incidence, current practice in airway management and prognosis were reviewed.
Background: The UK COVID-19 vaccination programme delivered both the BNT162b2 mRNA (Pfizer-BioNTech) and the ChAdOx1 (Oxford-AstraZeneca) vaccines during overlapping periods, providing a rare opportunity to emulate a trial that directly compares both vaccines using routinely-collected NHS data. Frontline Health and Social Care workers comprise a useful population to assess comparative effectiveness due to early vaccine eligibility and relatively high post-vaccination transmission risk due to occupational exposure. Methods: With the approval of NHS England we used the OpenSAFELY-TPP database, covering 40% of GP practices in England and linked to national coronavirus surveillance, hospital episodes, and death registry data, to compare the effectiveness of ChAdOx1 versus BNT162b2 in 1/3 million health and social care workers vaccinated between 4 January and 28 February 2021. Recipients were followed-up for 20 weeks. Second-dose effects were estimated under an intention-to-treat strategy. Primary outcomes were recorded SARS-CoV-2 infection, COVID-19-related accident and emergency attendance, and COVID-19-related hospital admission. Results: The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks post-vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 6 weeks after vaccination with BNT162b2 was 19.2 per 1000 people (95%CI 18.6 to 19.7) and with ChAdOx1 was 18.9 (95%CI 17.6 to 20.3), representing a difference of -0.24 per 1000 people (95%CI -1.71 to 1.22). The difference in the cumulative incidence of COVID-19 accident and emergency attendance at 6 weeks was 0.01 per 1000 people (95%CI -0.27 to 0.28). For COVID-19 hospital admission, this difference was 0.03 per 1000 people (95%CI -0.22 to 0.27). Conclusion: In this cohort of healthcare workers where we would not anticipate vaccine type to be related to health status, we found no substantial differences in the incidence of SARS-CoV-2 infection or COVID-19 disease up to 20 weeks after vaccination. Incidence dropped sharply after 3-4 weeks and there were very few COVID-19 hospital attendance and admission events after this period. This is in line with expected onset of vaccine-induced immunity, and suggests strong protection against COVID-19 disease for both vaccines.
BackgroundAll patients in England within vaccine priority groups were offered a COVID-19 vaccine by mid-April 2021. Clinical record systems contain codes to denote when such an offer has been declined by a patient (although these can in some cases be entered for a variety of other reasons including vaccination delay, or other administrative issues). We set out to describe the patterns of usage of codes for COVID-19 vaccines being declined.MethodsWith the approval of NHS England and using the full pseudonymised primary care records for 57.9 million NHS patients, we identified all patients in key vaccine priority groups: aged over 50, or over 16 and at increased risk from COVID-19 (Clinically Extremely Vulnerable [CEV] or otherwise “at risk”). We describe the proportion of patients recorded as declining a COVID-19 vaccination for each priority group, and by other clinical and demographic factors; whether patients recorded as “declined” subsequently went on to receive a vaccination; and the distribution of code usage across GP practices.ResultsOf 24.5 million patients in priority groups as of May 25th 2021, 89.2% had received a vaccine, 8.8% had neither a vaccination nor a decline recorded, and 663,033 (2.7%) had a decline code recorded. Of patients with a recorded decline, 125,587 (18.9%) were subsequently vaccinated. Subsequent vaccination was slightly more common in the South Asian population than other ethnicities (e.g. 32.3% vs 22.8%, over 65s). The proportion of declining-unvaccinated patients varied strongly with ethnicity (Black 15.3%, South Asian 5.6%, White 1.5% in over 80s); and was higher in patients from more deprived areas. COVID-19 vaccine decline codes were present in almost all practices (98.8%), but with wide variation between practices in rates of usage. Among all priority groups, declining-unvaccinated status was most common in CEV (3.3%).ConclusionsClinical codes indicative of COVID-19 vaccinations being declined are widely used in English general practice. They are substantially more common among Black and South Asian patients, and patients from more deprived areas. There is a need for more detailed survey and/or qualitative research with patients and clinicians to determine the most common reasons for these recorded declines.
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