Does a detailed assessment for heart disease help patients who have been admitted to hospital with a flare-up of chronic obstructive pulmonary disease (COPD)?

ISRCTN	ISRCTN26935612
DOI	https://doi.org/10.1186/ISRCTN26935612
ClinicalTrials.gov (NCT)	Nil known
Clinical Trials Information System (CTIS)	Nil known
Integrated Research Application System (IRAS)	277817
Protocol serial number	CPMS 47350, IRAS 277817
Sponsor	Northumbria Healthcare NHS Foundation Trust
Funders	Chiesi Farmaceutici, Northumbria Healthcare NHS Foundation Trust, National Institute for Health Research

Submission date: 03/10/2020
Registration date: 29/10/2020
Last edited: 10/06/2025

Recruitment status: No longer recruiting
Overall study status: Completed
Condition category: Circulatory System

Prospectively registered

Protocol

Statistical analysis plan

Results

Individual participant data

Plain English summary of protocol

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 May 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@nhs.net

Contact information

Dr John Steer
Scientific

Dept. Respiratory Medicine
North Tyneside General Hospital
Rake Lane
North Shields
NE29 8NH
United Kingdom

ORCID ID	0000-0003-4415-8814
Phone	+44 (0)191 293 4351
Email	John.Steer@northumbria-healthcare.nhs.uk

Dr Joseph Kibbler
Scientific

Dept. Respiratory Medicine
North Tyneside General Hospital
Rake Lane
North Shields
NE29 8NH
United Kingdom

Phone	+44 (0)191 293 4351
Email	joseph.kibbler@nhs.net

Study information

Primary study design	Interventional
Study design	Single-centre pilot randomized controlled trial
Secondary study design	Randomised controlled trial
Study type	Participant information sheet
Scientific title	Structured cardiac assessment and treatment following exacerbations of chronic obstructive pulmonary disease: a pilot randomised controlled trial
Study acronym	SCATECOPD
Study objectives	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(s)	Approved 23/11/2020, East of Scotland Research Ethics Service (EoSRES) (Ninewells Hospital & Medical School, Tayside Medical Science Centre (TASC), Residency Block, Level 3, George Pirie Way, Dundee, DD1 9SY; +44 (0)1382 383848; tay.eosres@nhs.scot), ref 20/ES/0112
Health condition(s) or problem(s) studied	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
Primary outcome measure(s)	The number of days spent alive outside of a hospital environment, measured using electronic hospital records during 12 months post hospital discharge
Key secondary outcome measure(s)	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
Completion date	31/05/2023

Eligibility

Participant type(s)	Patient
Age group	Adult
Lower age limit	35 Years
Sex	All
Target sample size at registration	120
Total final enrolment	115
Key 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
Key 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
Date of first enrolment	30/11/2020
Date of final enrolment	02/06/2022

Locations

Countries of recruitment

United Kingdom
England

Study participating centre

North Tyneside General Hospital

Northumbria Healthcare NHS Foundation Trust
Rake Lane
North Shields, Tyne and Wear
NE29 8NH
United Kingdom

Results and Publications

Individual participant data (IPD) Intention to share	Yes
IPD sharing plan summary	Available on request
IPD sharing plan	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.

Study outputs

Output type	Details	Date created	Date added	Peer reviewed?	Patient-facing?
Results article		07/03/2025	10/06/2025	Yes	No
HRA research summary			28/06/2023	No	No
Participant information sheet	Participant information sheet	11/11/2025	11/11/2025	No	Yes
Protocol file	version v1	01/09/2020	05/11/2020	No	No
Statistical Analysis Plan	version 1.0		11/04/2023	No	No

Additional files

ISRCTN26935612_PROTOCOL_v1_01Sept2020.pdf: uploaded 05/11/2020
ISRCTN26935612_SAP_V1.0.pdf: Statistical Analysis Plan

Editorial Notes

10/06/2025: Publication reference added.
13/02/2024: The intention to publish date was changed from 01/02/2024 to 01/04/2024.
04/12/2023: The intention to publish date was changed from 01/12/2023 to 01/02/2024.
06/10/2023: The following changes have been made:
1. The intention to publish date was changed from 01/10/2023 to 01/12/2023.
2. A scientific study contact was updated.
03/05/2023: The recruitment end date was changed from 31/05/2022 to 02/06/2022. Total final enrolment added.
11/04/2023: A statistical analysis plan (SAP) has been added.
29/04/2022: The following changes have been made:
1. The recruitment end date has been changed from 30/06/2022 to 31/05/2022.
2. The overall trial end date has been changed from 30/06/2023 to 31/05/2023 and the plain English summary has been updated to reflect this change.
3. The ethics approval has been added.
04/02/2022: The following changes were made to the trial record:
1. The recruitment end date was changed from 28/02/2022 to 30/06/2022.
2. The overall end date was changed from 28/02/2023 to 30/06/2023.
3. The plain English summary was updated to reflect these changes.
23/11/2020: The recruitment start date was changed from 16/11/2020 to 30/11/2020.
05/11/2020: Uploaded protocol (not peer reviewed) Version 1 01 September 2020.
06/10/2020: Trial's existence confirmed by Northumbria Healthcare NHS Foundation Trust.