Plain English Summary
Background and study aims
Chronic obstructive pulmonary disease (COPD) is a common lung disease which can flare up, requiring admission to hospital. Patients with COPD often have heart disease, which worsens their symptoms and increase the chances of death and hospital admission. In the short period after a flare-up of COPD, patients are also at a higher risk of heart attacks and irregular heart rhythms, which cause many hospital readmissions and deaths. Unfortunately, heart disease is often not recognised or not treated adequately in patients with COPD. The aim of this study is to test whether carefully finding and treating heart disease in patients admitted to hospital with COPD exacerbation is beneficial.
Who can participate?
Patients admitted to the Trust’s hospitals with an exacerbation of COPD can participate in the study, as long as they are over 35, have a confirmed diagnosis of COPD and do not fulfil any of the exclusion criteria.
What does the study involve?
The researchers will randomly divide participants into two equal groups. One will receive the usual care for exacerbations of COPD. The other group, called the intervention group, will receive this as well as a structured assessment for cardiovascular disease, with the treatment of any diseases identified as recommended in existing local and (inter)national guidelines. The researchers will compare the effect of adding this extra assessment and treatment on the number of days spent alive outside hospital over the subsequent year (this is the primary outcome of the study). The researchers will also measure how markers of strain on the heart change during and after COPD exacerbations in the participants that have the extra tests. Finally, they will assess how participants’ quality of life evolves during the study period, as well as assessing the healthcare services they use and the medications they are prescribed.
What are the possible benefits and risks of participating?
For participants who are assigned to the intervention group, it is hoped that it will be possible to identify heart problems at an early stage so that the right treatment can be started. Although it is not yet known for certain whether early identification and treatment of heart problems will have a positive impact on health, the researchers believe that it will. Participants assigned to the usual care group will still receive high quality, evidence-based care and will be help improve the treatment and prevention of COPD exacerbations. It is hoped that this will benefit other patients with COPD in future, and it may benefit the participants directly.
Where is the study run from?
Northumbria Healthcare NHS Foundation Trust (UK)
When is the study starting and how long is it expected to run for?
September 2020 to February 2023
Who is funding the study?
1. Chiesi Limited (UK)
2. Northumbria Healthcare NHS Foundation Trust (UK)
Who is the main contact?
1. Dr John Steer
John.Steer@northumbria-healthcare.nhs.uk
2. Dr Joe Kibbler
joseph.kibbler@northumbria-healthcare.nhs.uk
Trial website
Contact information
Type
Scientific
Primary contact
Dr John Steer
ORCID ID
http://orcid.org/0000-0003-4415-8814
Contact details
Dept. Respiratory Medicine
North Tyneside General Hospital
Rake Lane
North Shields
NE29 8NH
United Kingdom
+44 (0)191 293 4351
John.Steer@northumbria-healthcare.nhs.uk
Type
Scientific
Additional contact
Dr Joseph Kibbler
ORCID ID
Contact details
Dept. Respiratory Medicine
North Tyneside General Hospital
Rake Lane
North Shields
NE29 8NH
United Kingdom
+44 (0)191 293 4351
joseph.kibbler@northumbria-healthcare.nhs.uk
Additional identifiers
EudraCT number
Nil known
ClinicalTrials.gov number
Nil known
Protocol/serial number
CPMS 47350, IRAS 277817
Study information
Scientific title
Structured cardiac assessment and treatment following exacerbations of chronic obstructive pulmonary disease: a pilot randomised controlled trial
Acronym
SCATECOPD
Study hypothesis
A comprehensive, structured cardiovascular assessment, with treatment of problems identified, increases the time patients spend alive outside of hospital following hospital admission for a COPD exacerbation.
Ethics approval
Approval pending
Study design
Single-centre pilot randomized controlled trial
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Hospitals
Trial type
Screening
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet
Condition
Identification of cardiovascular disease (CVD) in patients admitted to hospital with COPD exacerbations.
Intervention
Participants will be randomized to receive usual care for COPD exacerbation, or to receive usual care plus structured assessment for cardiovascular disease. Stratified randomisation by the presence of known cardiovascular disease and PEARL score (a validated method of predicting the likelihood of readmission with COPD exacerbation) will be used.
Cardiovascular disease identified by the structured assessment will be treated according to current UK standard care in keeping with local and/or national guidance. The intervention is a detailed cardiovascular assessment: transthoracic echocardiography, cardiac biomarker assessment, 24-h cardiac monitoring, CT coronary artery calcification quantification, and assessment for hypertension. Treatment of identified cardiovascular disease will be in line with current local and/or national guidance and will be led by the usual care team.
Participants will be reviewed clinically 90 days and 12 months following hospital discharge. All will undergo a clinical assessment, spirometry, quality of life questionnaires, assessment of walking speed, and an assessment of health resource use. At 90 days, those in the intervention arm will have repeat electrocardiography, transthoracic echocardiography and cardiac biomarker measurements. Participants will also be contacted by telephone at 6 and 9 months after discharge to gather information about their medication use and interaction with healthcare services.
Intervention type
Mixed
Phase
Drug names
Primary outcome measure
The number of days spent alive outside of a hospital environment, measured using electronic hospital records during 12 months post hospital discharge
Secondary outcome measures
1. Time to readmission or death following hospital admission for ECOPD, collected from hospital health records using Patient Administration System (PAS)
2. All-cause readmission rates at 90 days and 12 months post discharge, collected from hospital health records using Patient Administration System (PAS)
3. All-cause mortality rates at 90 days and 12 months post discharge, collected from hospital health records using Patient Administration System (PAS)
4. COPD exacerbation rates, from health records and self-report, at 90 days and 12 months
5. Rates of adverse cardiovascular events (nonfatal stroke or myocardial infarction, and cardiovascular death) at 90 days and 12 months post discharge
6. Rate of new diagnosis of cardiovascular disease at 90 days and 12 months
7. Rate of undertreated cardiovascular disease at baseline, 90 days and 12 months
8. Change in 4-m gait speed at 90 days and 12 months, compared to baseline
9. Mean change in quality of life measured by St. Georges' Respiratory Questionnaire over 12 months
10. Health costs and estimated Quality-Adjusted Life Years (QALY), measured by health records and patient-completed resource utilisation proforma, at 12 months
In the intervention arm the researchers will also report as secondary outcomes:
11. Changes in right heart function (estimated pulmonary artery systolic pressure [PASP] and tricuspid annular plane systolic excursion [TAPSE] measured by echocardiography) between baseline and 90 days
12. Relationship between changes in right heart function (estimated pulmonary artery systolic pressure [PASP] and tricuspid annular plane systolic excursion [TAPSE] measured by echocardiography) and ECOPD severity measured using DECAF score at admission and 90 days
13. Relationship between changes in right heart function (estimated pulmonary artery systolic pressure [PASP] and tricuspid annular plane systolic excursion [TAPSE] measured by echocardiography) and comorbid CVD at admission and 90 days
14. Relationship between right heart function (estimated pulmonary artery systolic pressure [PASP] and tricuspid annular plane systolic excursion [TAPSE] measured by echocardiography) and COPD severity at baseline
15. The associations between the primary outcome and right heart function (estimated pulmonary artery systolic pressure [PASP] and tricuspid annular plane systolic excursion [TAPSE] measured by echocardiography) at baseline
Overall trial start date
01/09/2020
Overall trial end date
28/02/2023
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Age >35 years
2. Current/former smoker & smoking burden >10 pack-years
3. Clinical diagnosis of COPD, supported by previous obstructive spirometry
4. Admission to hospital with the primary cause being an exacerbation of COPD
Participant type
Patient
Age group
Adult
Gender
Both
Target number of participants
120
Participant exclusion criteria
1. Reason for admission not ECOPD in view of attending clinical team
2. Unable to provide informed consent
3. Any non-COPD condition likely to limit survival to less than 12 months
4. Contraindication to non contrast CT scan
5. Pregnancy or breastfeeding
Recruitment start date
30/11/2020
Recruitment end date
28/02/2022
Locations
Countries of recruitment
United Kingdom
Trial participating centre
North Tyneside General Hospital
Northumbria Healthcare NHS Foundation Trust
Rake Lane
North Shields, Tyne and Wear
NE29 8NH
United Kingdom
Sponsor information
Organisation
Northumbria Healthcare NHS Foundation Trust
Sponsor details
Research and Development
Education Centre
North Tyneside General Hospital
Rake Lane
North Shields
NE29 8NH
United Kingdom
+44 (0)191 293 4087
researchanddevelopment@nhct.nhs.uk
Sponsor type
Hospital/treatment centre
Website
Funders
Funder type
Industry
Funder name
Chiesi Farmaceutici
Alternative name(s)
Chiesi Pharmaceuticals, Chiesi
Funding Body Type
private sector organisation
Funding Body Subtype
For-profit companies (industry)
Location
Italy
Funder name
Northumbria Healthcare NHS Foundation Trust
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
National Institute for Health Research
Alternative name(s)
NIHR
Funding Body Type
government organisation
Funding Body Subtype
National government
Location
United Kingdom
Results and Publications
Publication and dissemination plan
The researchers plan to present preliminary results at an international conference at the end of 2022 / early 2023 with the publication of the main paper in a leading peer-reviewed journal towards the end of 2023.
IPD sharing statement
Anonymised participant-level data can be shared after the main results have been published. Applications should be made to the Trial Steering Committee who will consider all requests.
Intention to publish date
01/10/2023
Participant level data
Available on request
Basic results (scientific)
Publication list
Publication citations
Additional files
- ISRCTN26935612_PROTOCOL_v1_01Sept2020.pdf uploaded 05/11/2020