SP - Respiratory

Introduction Frailty is a clinical state that predisposes to patients to clinical deterioration in response to minor stressor events. Frailty tends to be more prevalent in patients with chronic conditions such as Chronic Obstructive Pulmonary Disease (COPD). Therefore, we aim to investigate the influence of clinical frailty on mortality in COPD patients. Methods Data collection from electronic records for patients seen in Ysbyty Ystrad Fawr, Neville Hall Hospital, Grange University Hospital or Royal Gwent Hospital between 5-17th June 2024 was completed as part of patient input to the National Respiratory Audit Programme, focussing on patients who were admitted with an acute COPD exacerbation. The data collected were clinical frailty as measured by the Clinical Frailty Scale (CFS), smoking status, and the life status of patients at the time of data collection. This data was then exported to an excel spreadsheet, anonymised and simplified for statistical analysis using chi squared tests. Results Of the total 209 patients, 84 were male and 125 were female; the mean age was 72. 113 patients were ex-smokers, 71 were current smokers, 7 had never smoked and 18 were not recorded. 97 patients had a CFS of 5 or above, 112 had a CFS of 4 or below. 48% of ex-smokers were frail whereas 40% of current smokers were frail (p=0.478). 161 patients were alive at the time of data collection. 29% of those classed as frail had died since their admission whereas 17.6% of those classed as not frail had died following their admission (p=0.030). Of those alive, 41.2% were still smokers on admission. Of those dead, only 25.6% were still smokers on admission (p=0.055). Conclusion COPD patients who are frail tend to have higher rates of mortality compared to those who are not. Future studies exploring the relationship between smoking and frailty are needed.

BACKGROUND

• RSV is one of the most common causes of seasonal respiratory infections worldwide, with a marked global burden in older adults and those with significant underlying medical conditions.1-5 It is increasingly clear that RSV infections in older adults in the United Kingdom significantly impact the already strained public health system, especially during the winter months.
• However, the true burden remains underestimated,6,7 as estimates in the UK are likely to be conservative due to the limitations in testing and diagnostic coding practices.

OBJECTIVES

• We conducted a TLR of existing literature to investigate the disease burden of RSV infection in older adults, aged 60 years and older in the UK, and to highlight potential evidence gaps. METHODS • We searched OVID MEDLINE, Embase, and EconLit to identify existing literature from January 2011 to August 2023, including an additional search for grey literature. Eligibility criteria were defined based on population (intervention/comparator [no limit]), outcomes (clinical, epidemiological, economic, and quality of life) and limited to UK-only results. See PRISMA flowchart for details.

RESULTS

• In the OVID search, we identified 1,001 records, and in the supplementary search, 12 records of possible interest were identified. All records were screened against the predefined eligibility criteria. Despite the relatively broad screening criteria, only 14 studies could be included.
• There were four model studies, five cohort studies, and five time series analyses included. Of these, nine studies reported on epidemiology, one study informed both on epidemiology and costs, and four studies reported on model outcomes. Nine studies reported unique data on the UK and five studies included data from several countries, including the UK.
  • All identified studies emphasised the challenges in estimating the true RSV burden in the UK due to limitations in testing and a lack of standardised disease definition in older adults. There is a lack of evidence for adult risk groups, particularly clinical and economic consequences in patients at a higher risk of RSV infection and severe sequelae.
  • Due to the overall small number of studies and the heterogeneity of study design and outcomes reported, it was not possible to establish reliable data on incidence, prevalence, and mortality in the UK.

• The results of the TLR suggest that RSV infection in older adults may place a high economic burden on the UK’s healthcare system.

CONCLUSIONS

• A limited number of studies meeting the criteria on RSV infection in older adults in the UK were found, with nearly no data on adult risk groups and related cost. The scarcity of data, lack of standardised disease definitions and surveillance methodologies likely lead to an underestimation of RSV disease burden in older adults in the UK.
• It is imperative that surveillance systems are improved to understand the true burden. Therefore, a deeper comprehension of the impact of RSV infection within this population would enhance the ability to demonstrate the cost-effectiveness of a national immunisation programme more reliably.
• This paucity of data creates great challenges for the Joint Committee on Vaccination and Immunisation, and UK policymakers to make informed decisions on the population benefit of RSV vaccination programmes for older adults.

ADDITIONAL INFORMATION

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REFERENCES

1. Nguyen-Van-Tam, J.S., et al., Burden of respiratory syncytial virus infection in older and high-risk adults: a systematic review and meta-analysis of the evidence from developed countries. European Respiratory Review, 2022. 31(166): p. 220105.

2. Falsey, A.R., et al., Respiratory syncytial virus infection in elderly and high-risk adults. New England Journal of Medicine, 2005. 352(17): p. 1749-1759.

3. Falsey, A.R., et al., Respiratory syncytial virus–associated illness in adults with advanced chronic obstructive pulmonary disease and/or congestive heart failure. Journal of Medical Virology, 2019. 91(1): p. 65-71.

4. Global Burden of Disease 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infectious Diseases, 2018. 18(11): p. 1191-1210.

5. Savic, M., et al., Respiratory syncytial virus disease burden in adults aged 60 years and older in high‐income countries: a systematic literature review and meta‐analysis. Influenza and Other Respiratory Viruses, 2023. 17(1): p. e13031.

6. Korsten, K., et al., Burden of respiratory syncytial virus infection in community-dwelling older adults in Europe (RESCEU): an international prospective cohort study. European Respiratory Journal, 2021. 57(4): p. 2002688.

7. Sharp, A., et al., Estimating the burden of adult hospital admissions due to RSV and other respiratory pathogens in England. Influenza and Other Respiratory Viruses, 2022. 16(1): p. 125-131.

ACKNOWLEDGEMENTS

Writing and/or editorial assistance was provided by MEDiSTRAVA and was funded by Moderna, Inc. This study was funded by Moderna, Inc.

DISCLOSURES

ICON (MM, BB) was commissioned by Moderna, Inc., to conduct the TLR. SC, MD, OB and TA are employees of Moderna, Inc., and hold stock/stock options in the company.