Changes in Care during the COVID-19 Pandemic for People with Cystic Fibrosis
Don B Sanders1, Runyu Wu2, Tom O'Neil2
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
During the COVID-19 pandemic, cystic fibrosis (CF) care shifted to telemedicine. In-person visits showed improved lung function and BMI in children and those eligible for elexacaftor-tezacaftor-ivacaftor (ETI) therapy.
Area of Science:
- Pulmonary Medicine
- Epidemiology
- Health Services Research
Background:
- The COVID-19 pandemic necessitated a rapid shift to telemedicine in cystic fibrosis (CF) care.
- Understanding the impact of this transition on patient outcomes is crucial for optimizing future care models.
Purpose of the Study:
- To investigate changes in clinical outcomes for people with CF (pwCF) during the initial phase of the COVID-19 pandemic.
- To determine if pwCF with more severe disease were more likely to receive in-person care.
- To compare lung function and body mass index (BMI) between 2019 and 2020 for pwCF who had in-person visits in both years.
Main Methods:
- Utilized data from the CF Foundation Patient Registry for pwCF with at least one in-person visit in both 2019 and 2020.
- Employed paired t-tests to analyze changes in BMI and forced expiratory volume in one second (FEV1).
- Calculated relative risk (RR) to compare the incidence of pulmonary exacerbations (PEx) between the two years.
Main Results:
- The proportion of in-person visits decreased significantly from 91% in 2019 to 9% in April 2020.
- PwCF aged 6 to <12 years and those ⩾12 years eligible for elexacaftor-tezacaftor-ivacaftor (ETI) showed higher FEV1 in 2020 compared to 2019.
- Improvements in BMI were observed in children and adolescents eligible for ETI, and in adults eligible and not eligible for ETI.
- The rate of PEx during in-person visits was lower in 2020 (25%) compared to 2019 (38%).
Conclusions:
- The COVID-19 pandemic significantly altered CF care delivery, with a substantial increase in telemedicine utilization.
- In-person visits during the pandemic were associated with better lung function and BMI in specific pediatric and adult populations, particularly those benefiting from ETI.
- The findings suggest that while telemedicine is valuable, in-person care remains critical for managing CF, especially for certain patient groups.
Abstract:
Rationale: Cystic fibrosis (CF) centers transitioned to telemedicine during the spring 2020 peak of the coronavirus disease (COVID-19) pandemic. Objectives: We hypothesized that people with CF (pwCF) with more severe disease would be more likely to be seen in-person. Methods: We used paired t tests to compare within-subject changes in body mass index (BMI) and percentage predicted forced expiratory volume in one second (FEV1) and calculated relative risk (RR) to compare pulmonary exacerbations (PEx) between pwCF enrolled in the CF Foundation Patient Registry with at least one in-person clinic visit after March 15 in both 2019 and 2020. Results: Overall, the proportion of clinical encounters that were in-person clinic visits decreased from 91% in 2019 to a low of 9% in April 2020. Among pwCF seen after March 15 in both 2019 and 2020, the mean (95% confidence interval [CI]) FEV1 percentage predicted was 1.3% (0.1-2.4) predicted higher in 2020 for children 6 to <12 years of age, and 7.5% (7.1-7.9) predicted higher in 2020 among pwCF ⩾12 years of age eligible for the highly effective CF transmembrane conductance regulator modulator, elexacaftor-tezacaftor-ivacaftor (ETI). There was no difference in FEV1 percentage predicted for pwCF ⩾12 years of age who were not eligible for ETI. Similarly, the mean (95% CI) BMI was 2.4 (2.0-2.8) percentile higher in 2020 for children 6 to <12 years of age and 5.2 (4.8-5.7) percentile higher in 2020 among children 12 to <18 years of age eligible for ETI. Mean (95% CI) BMI was 1.2 (1.2-1.3) (kg/m2) higher for pwCF ⩾18 years of age eligible for ETI, and 0.2 (0.1-0.3) (kg/m2) higher for pwCF ⩾18 years of age not eligible for ETI. The proportion of in-person clinic visits where any PEx was present was lower in 2020 compared with 2019, 25% compared with 38%, RR 0.82 (0.79-0.86). Conclusions: The care of pwCF was substantially changed during the spring 2020 peak of the COVID-19 pandemic. Among pwCF seen in-person in both 2019 and 2020 after the spring peak of the COVID-19 pandemic, lung function and BMI were higher in 2020 for children 6 to <12 years of age and pwCF eligible for ETI.
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