DOCSLIB.ORG

Risk Factors for Diagnostic Delay in Idiopathic Pulmonary Fibrosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Risk Factors for Diagnostic Delay in Idiopathic Pulmonary Fibrosis View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Copenhagen University Research Information System Risk factors for diagnostic delay in idiopathic pulmonary fibrosis Hoyer, Nils; Prior, Thomas Skovhus; Bendstrup, Elisabeth; Wilcke, Torgny; Shaker, Saher Burhan Published in: Respiratory research DOI: 10.1186/s12931-019-1076-0 Publication date: 2019 Document version Publisher's PDF, also known as Version of record Document license: CC BY Citation for published version (APA): Hoyer, N., Prior, T. S., Bendstrup, E., Wilcke, T., & Shaker, S. B. (2019). Risk factors for diagnostic delay in idiopathic pulmonary fibrosis. Respiratory research, 20, [103]. https://doi.org/10.1186/s12931-019-1076-0 Download date: 27. maj. 2020 Hoyer et al. Respiratory Research (2019) 20:103 https://doi.org/10.1186/s12931-019-1076-0 RESEARCH Open Access Risk factors for diagnostic delay in idiopathic pulmonary fibrosis Nils Hoyer1* , Thomas Skovhus Prior2, Elisabeth Bendstrup2, Torgny Wilcke1 and Saher Burhan Shaker1 Abstract Background: Surveys and retrospective studies of patients with idiopathic pulmonary fibrosis (IPF) have shown a significant diagnostic delay. However, the causes and risk factors for this delay are not known. Methods: Dates at six time points before the IPF diagnosis (onset of symptoms, first contact to a general practitioner, first hospital contact, referral to an interstitial lung disease (ILD) centre, first visit at an ILD centre, and final diagnosis) were recorded in a multicentre cohort of 204 incident IPF patients. Based on these dates, the delay was divided into specific patient-related and healthcare-related delays. Demographic and clinical data were used to determine risk factors for a prolonged delay, using multivariate negative binomial regression analysis. Results: The median diagnostic delay was 2.1 years (IQR: 0.9–5.0), mainly attributable to the patients, general practitioners and community hospitals. Male sex was a risk factor for patient delay (IRR: 3.84, 95% CI: 1.17–11.36, p = 0.006) and old age was a risk factor for healthcare delay (IRR: 1.03, 95% CI: 1.01–1.06, p = 0.004). The total delay was prolonged in previous users of inhalation therapy (IRR: 1.99, 95% CI: 1.40–2.88, p < 0.0001) but not in patients with airway obstruction. Misdiagnosis of respiratory symptoms was reported by 41% of all patients. Conclusion: Despite increased awareness of IPF, the diagnostic delay is still 2.1 years. Male sex, older age and treatment attempts for alternative diagnoses are risk factors for a delayed diagnosis of IPF. Efforts to reduce the diagnostic delay should focus on these risk factors. Trial registration: This study was registered at http://clinicaltrials.gov (NCT02772549) on May 10, 2016. Keywords: IPF, Diagnosis, Delay, Cohort, Observational Background prognosis [5]. Current medical treatment of IPF can slow Idiopathic Pulmonary Fibrosis (IPF) is a debilitating down the progression of the disease but does not seem chronic lung disease. Despite recent advances in antifi- to reverse any fibrotic changes that already have oc- brotic therapy, the prognosis is poor with a median sur- curred [9–11]. Timely diagnosis is therefore important vival of 2–5 years [1, 2]. The diagnosis of IPF can be in order to initiate early treatment, prevent lung tissue challenging, and due to its rarity, few physicians gain from developing fibrosis, delay disease progression and enough expertise to become familiar with the disease. In prolong survival [4, 8]. addition, the diagnosis often requires a multidisciplinary The cause of the diagnostic delay is not well known team, which is not available in all centres [3, 4]. Surveys but is probably multifactorial. Surveys suggest that mis- and retrospective studies have shown a significant diag- interpretation of respiratory symptoms could be a con- nostic delay from the onset of symptoms until the final tributing factor [6, 12]. The first symptoms of IPF are diagnosis is made [5–8]. This results in a delayed start of often cough and shortness of breath, which are often at- effective antifibrotic treatment and lung transplant tributed to old age, smoking or more common cardio- evaluation, and can affect the disease course and vascular or respiratory diseases by either the patient or healthcare professionals as it is the case in patients with chronic obstructive pulmonary disease (COPD) [13]. * Correspondence: [email protected] 1Department of Respiratory Medicine, Herlev and Gentofte Hospital, The distribution of the diagnostic delay between Kildegårdsvej 28, 2900 Hellerup, Denmark patient-related and healthcare-related causes is still Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Hoyer et al. Respiratory Research (2019) 20:103 Page 2 of 9 largely unknown. Moreover, we are not aware of any severity were collected from the patients’ electronic re- studies detailing the risk factors for a delayed diagnosis. cords: comprehensive pulmonary function tests with spir- A thorough understanding of these risk factors is essen- ometry and diffusing capacity for carbon monoxide tial for any attempts to reduce the diagnostic delay. (DLCO), six-minute walk test (6MWT) and high reso- To answer these questions, we used a well character- lution computed tomography (HRCT) scan. ized multicentre cohort of incident IPF patients to inves- The diagnostic delay was calculated based on six tigate the diagnostic delay and determine specific risk pre-defined time points on the patients’ path towards an factors for a delayed diagnosis. IPF diagnosis (Fig. 1). The first two time points (dates of symptom onset and first contact with a general practi- Materials and methods tioner) were part of the survey which was completed by Patient cohort each patient shortly after their diagnosis. All remaining The Pulmonary Fibrosis Biomarker (PFBIO) cohort pro- time points were collected from the patients’ electronic re- spectively recruits incident patients with IPF from two cords. The specific delays were calculated from these time large interstitial lung disease (ILD) centres in Denmark points and are illustrated in Fig. 1. If a time point was not serving a population of 4.2 million. The main purpose of relevant in a patient’s path towards an IPF diagnosis (i.e. if the cohort is to follow a broad population of patients the first contact with a physician was at a community hos- with IPF and create a biorepository for biomarker re- pital or if a patient was referred directly to an ILD centre search. Antifibrotic therapy is centralized in Denmark by the general practitioner), the jumped delay was ex- and referral to one of the three specialized ILD centres cluded for that patient in the statistical analysis. is necessary for patients to be eligible for treatment. Re- cruitment for the PFBIO cohort started in 2016 and is Statistical analysis still ongoing at one of the participating centres (Gentofte Descriptive data are presented as frequency tables, mean Hospital) for future studies. At the time of analysis, the (SD) or median (interquartile range, IQR) as appropriate cohort had included 204 patients. All participants had for the data. Univariate analyses of baseline characteris- received a diagnosis of IPF according to the 2011 ATS/ tics were performed with a t-test or chi-squared test as ERS/JRS/ALAT guidelines at an ILD centre, based on a appropriate for the data. multidisciplinary team approach [3, 14]. Patients were None of the specific delays were normally distributed recruited on the same day as they received the diagnosis and are presented as medians with IQR. We used multi- or up to a maximum of two months later but prior to variate negative binomial regression models to deter- initiating antifibrotic treatment. All patients with IPF mine specific risk factors for patient delay, healthcare were eligible for participation unless they were unable to delay and total delay respectively, as the delays were provide written informed consent. A flowchart of the re- counts of days and did not fit a Poisson distribution. cruitment process is presented in the Additional files 1. Covariates were tested for normality before inclusion into any statistical analysis. Missing data were handled by Data collection listwise deletion using complete cases without any imput- Patients completed a detailed survey at the time of diag- ation of data. nosis which was followed up by an interview if needed for clarification (see Additional file 1). The survey included Ethics, consent and permissions questions about the onset of symptoms, initial healthcare All participants were included after written informed con- contact, smoking history, alternative diagnoses for respira- sent, and none had chosen to withdraw from the study at tory symptoms, and previous therapies. The patients’ the time of analysis. The study has been approved by the quality of life was assessed by the St. George’sRespiratory Capital Region regional ethics committee (H-16001790) Questionnaire (SGRQ) with higher scores indicating and the Danish Data Protection Agency (HGH-2016-017). worse quality of life [15]. Several measures of disease The study was also registered at http://clinicaltrials.gov Fig. 1 Diagnostic delay from patients’ awareness of symptoms until an IPF diagnosis is made. The total delay is divided into patient delay and healthcare delay (GP delay, hospital delay, waiting delay and specialized delay combined) Hoyer et al.
Load more

Recommended publications
  • Diagnostic Delay and Associated Factors Among Patients With
    Said et al. Infectious Diseases of Poverty (2017) 6:64 DOI 10.1186/s40249-017-0276-4 RESEARCH ARTICLE Open Access Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam, Tanzania Khadija Said1,2,3*, Jerry Hella1,2,3, Grace Mhalu1,2,3, Mary Chiryankubi4, Edward Masika4, Thomas Maroa1, Francis Mhimbira1,2,3, Neema Kapalata4 and Lukas Fenner1,2,3,5* Abstract Background: Tanzania is among the 30 countries with the highest tuberculosis (TB) burdens. Because TB has a long infectious period, early diagnosis is not only important for reducing transmission, but also for improving treatment outcomes. We assessed diagnostic delay and associated factors among infectious TB patients. Methods: We interviewed new smear-positive adult pulmonary TB patients enrolled in an ongoing TB cohort study in Dar es Salaam, Tanzania, between November 2013 and June 2015. TB patients were interviewed to collect information on socio-demographics, socio-economic status, health-seeking behaviour, and residential geocodes. We categorized diagnostic delay into ≤ 3 or > 3 weeks. We used logistic regression models to identify risk factors for diagnostic delay, presented as crude (OR) and adjusted Odds Ratios (aOR). We also assessed association between geographical distance (incremental increase of 500 meters between household and the nearest pharmacy) with binary outcomes. Results: We analysed 513 patients with a median age of 34 years (interquartile range 27–41); 353 (69%) were men. Overall, 444 (87%) reported seeking care from health care providers prior to TB diagnosis, of whom 211 (48%) sought care > 2 times. Only six (1%) visited traditional healers before TB diagnosis.
    [Show full text]
  • Patient and Health System Delay Among TB Patients in Ethiopia: Nationwide Mixed Method Cross-Sectional Study Daniel G
    Datiko et al. BMC Public Health (2020) 20:1126 https://doi.org/10.1186/s12889-020-08967-0 RESEARCH ARTICLE Open Access Patient and health system delay among TB patients in Ethiopia: Nationwide mixed method cross-sectional study Daniel G. Datiko1* , Degu Jerene1 and Pedro Suarez2 Abstract Background: Effective tuberculosis (TB) control is the end result of improved health seeking by the community and timely provision of quality TB services by the health system. Rapid expansion of health services to the peripheries has improved access to the community. However, high cost of seeking care, stigma related TB, low index of suspicion by health care workers and lack of patient centered care in health facilities contribute to delays in access to timely care that result in delay in seeking care and hence increase TB transmission, morbidity and mortality. We aimed to measure patient and health system delay among TB patients in Ethiopia. Methods: This is mixed method cross-sectional study conducted in seven regions and two city administrations. We used multistage cluster sampling to randomly select 40 health centers and interviewed 21 TB patients per health center. We also conducted qualitative interviews to understand the reasons for delay. Results: Of the total 844 TB patients enrolled, 57.8% were men. The mean (SD) age was 34 (SD + 13.8) years. 46.9% of the TB patients were the heads of household, 51.4% were married, 24.1% were farmers and 34.7% were illiterate. The median (IQR) patient, diagnostic and treatment initiation delays were 21 (10–45), 4 (2–10) and 2 (1–3) days respectively.
    [Show full text]
  • Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients
    ORIGINAL RESEARCH published: 30 April 2021 doi: 10.3389/fmed.2021.637375 Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients Federica Melazzini 1*, Margherita Reduzzi 1, Silvana Quaglini 2, Federica Fumoso 1, Marco Vincenzo Lenti 1 and Antonio Di Sabatino 1* 1 Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy, 2 Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Pavia, Italy Pulmonary embolism (PE) is a frequent, life-threatening COVID-19 complication, whose diagnosis can be challenging because of its non-specific symptoms. There are no studies assessing the impact of diagnostic delay on COVID-19 related PE. The aim of our exploratory study was to assess the diagnostic delay of PE in COVID-19 patients, and to identify potential associations between patient- or physician-related variables and the delay. This is a single-center observational retrospective study that included 29 consecutive COVID-19 patients admitted to the San Matteo Hospital Foundation between February and May 2020, with a diagnosis of PE, and a control population of Edited by: Zisis Kozlakidis, 23 non-COVID-19 patients admitted at our hospital during the same time lapse in 2019. International Agency for Research on We calculated the patient-related delay (i.e., the time between the onset of the symptoms Cancer (IARC), France and the first medical examination), and the physician-related delay (i.e., the time between Reviewed by: the first medical examination and the diagnosis of PE). The overall diagnostic delay Pedro Xavier-Elsas, Federal University of Rio de significantly correlated with the physician-related delay (p < 0.0001), with the tendency Janeiro, Brazil to a worse outcome in long physician-related diagnostic delay (p = 0.04).
    [Show full text]
  • Diagnostic Test Interpretation and Referral Delay in Patients with Interstitial Lung Disease
    UC Davis UC Davis Previously Published Works Title Diagnostic test interpretation and referral delay in patients with interstitial lung disease. Permalink https://escholarship.org/uc/item/282365v7 Journal Respiratory research, 20(1) ISSN 1465-9921 Authors Pritchard, David Adegunsoye, Ayodeji Lafond, Elyse et al. Publication Date 2019-11-12 DOI 10.1186/s12931-019-1228-2 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Pritchard et al. Respiratory Research (2019) 20:253 https://doi.org/10.1186/s12931-019-1228-2 RESEARCH Open Access Diagnostic test interpretation and referral delay in patients with interstitial lung disease David Pritchard1, Ayodeji Adegunsoye2, Elyse Lafond3, Janelle Vu Pugashetti4, Ryan DiGeronimo5, Noelle Boctor1, Nandini Sarma1, Isabella Pan2, Mary Strek2, Michael Kadoch5, Jonathan H. Chung6 and Justin M. Oldham4,7* Abstract Background: Diagnostic delays are common in patients with interstitial lung disease (ILD). A substantial percentage of patients experience a diagnostic delay in the primary care setting, but the factors underpinning this observation remain unclear. In this multi-center investigation, we assessed ILD reporting on diagnostic test interpretation and its association with subsequent pulmonology referral by a primary care physician (PCP). Methods: A retrospective cohort analysis of patients referred to the ILD programs at UC-Davis and University of Chicago by a PCP within each institution was performed. Computed tomography (CT) of the chest and abdomen and pulmonary function test (PFT) were reviewed to identify the date ILD features were first present and determine the time from diagnostic test to pulmonology referral. The association between ILD reporting on diagnostic test interpretation and pulmonology referral was assessed, as was the association between years of diagnostic delay and changes in fibrotic features on longitudinal chest CT.
    [Show full text]
  • Delayed Diagnosis of Acute Ischemic Stroke in Children - a Registry-Based Study in Switzerland
    Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2011 Delayed diagnosis of acute ischemic stroke in children - a registry-based study in Switzerland Martin, C ; von Elm, E ; El-Koussy, M ; Boltshauser, E ; Steinlin, M Abstract: QUESTIONS UNDER STUDY/PRINCIPLES: After arterial ischemic stroke (AIS) an early diagnosis helps preserve treatment options that are no longer available later. Paediatric AIS is difficult to diagnose and often the time to diagnosis exceeds the time window of 6 hours defined for thrombolysis in adults. We investigated the delay from the onset of symptoms to AIS diagnosis in children and potential contributing factors. METHODS: We included children with AIS below 16 years from the population- based Swiss Neuropaediatric Stroke Registry (2000-2006). We evaluated the time between initial medical evaluation for stroke signs/symptoms and diagnosis, risk factors, co-morbidities and imaging findings. RESULTS: A total of 91 children (61 boys), with a median age of 5.3 years (range: 0.2-16.2), were included. The time to diagnosis (by neuro-imaging) was <6 hours in 32 (35%), 6-12 hours in 23 (25%), 12-24 hours in 15 (16%) and >24 hours in 21 (23%) children. Of 74 children not hospitalised when the stroke occurred, 42% had adequate outpatient management. Delays in diagnosis were attributed to: parents/caregivers (n = 20), physicians of first referral (n = 5) and tertiary care hospitals (n= 8). A co-morbidity hindered timely diagnosis in eight children. No other factors were associated with delay to diagnosis.
    [Show full text]
  • Factors Associated with Diagnostic Delay of Pulmonary Tuberculosis in China
    Factors Associated With Diagnostic Delay of Pulmonary Tuberculosis in China Caihong Xu National Center for Tuberculosis Control and Prevention Xiaomeng Zhang Tianjin center for tuberculosis control Yan Liu Peking UnionMedical CollegeBeijingChina Yinyin Xia National Center for Tuberculosis Control and Prevention Li Wang Institute of Basic Medical Sciences Chinese Academy of Medical Sciences Lixia Wang National Center for Tuberculosis Control and Prevention Hui Zhang ( [email protected] ) National Center for Tuberculosis Control and Prevention, China Centre for Disease Control (CDC) https://orcid.org/0000-0002-3989-2304 Research Article Keywords: Diagnosis, Delay, Pulmonary tuberculosis Posted Date: April 13th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-404351/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/19 Abstract Background Tuberculosis (TB) is still a great challenge to public health in China. Most of the transmission occurs between the onset of symptoms and initiation of treatment. Diagnosis delay is a major barrier to effective management of the disease. Determining the factors associated with patient and provider delay of TB diagnosis and treatment may contribute to TB prevention and control. Methods A cross-sectional survey of pulmonary tuberculosis registed in the National Tuberculosis programme was conducted in 22 counties of 6 provinces in China. All consecutively registered patients during January to June 2017 were interviewed using a structured questionnaire. The time from the onset of symptoms to the date of diagnosis was analyzed. Bivariate and logistics regression were applied to analyze the risk factors of delay. Results The median time from onset of symptoms to diagnosis was 23 days (interquartile range [IQR]: 5-53days).
    [Show full text]
  • Diagnostic and Treatment Delay in Tuberculosis
    WHO-EM/TDR/009/E Diagnostic and treatment delay in tuberculosis An in-depth analysis of the health-seeking behaviour of patients and health system response in seven countries of the Eastern Mediterranean Region © World Health Organization 2006 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Publications of the World Health Organization can be obtained from Distribution and Sales, World Health Organization, Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt (tel: +202 670 2535, fax: +202 670 2492; email: [email protected]). Requests for permission to reproduce WHO EMRO publications, in part or in whole, or to translate them – whether for sale or for noncommercial distribution – should be addressed to the Regional Adviser, Health and Biomedical Information, at the above address (fax: +202 276 5400; email [email protected].) Cover design by DAT advertising Printed in Cairo, Egypt, by Metropole Document WHO-EM/TDR/009/E/10.06/1000 Contents Preface........................................................................................................................................................
    [Show full text]
  • Risk Factors for Diagnostic Delay in Idiopathic Pulmonary Fibrosis Nils Hoyer1* , Thomas Skovhus Prior2, Elisabeth Bendstrup2, Torgny Wilcke1 and Saher Burhan Shaker1
    Hoyer et al. Respiratory Research (2019) 20:103 https://doi.org/10.1186/s12931-019-1076-0 RESEARCH Open Access Risk factors for diagnostic delay in idiopathic pulmonary fibrosis Nils Hoyer1* , Thomas Skovhus Prior2, Elisabeth Bendstrup2, Torgny Wilcke1 and Saher Burhan Shaker1 Abstract Background: Surveys and retrospective studies of patients with idiopathic pulmonary fibrosis (IPF) have shown a significant diagnostic delay. However, the causes and risk factors for this delay are not known. Methods: Dates at six time points before the IPF diagnosis (onset of symptoms, first contact to a general practitioner, first hospital contact, referral to an interstitial lung disease (ILD) centre, first visit at an ILD centre, and final diagnosis) were recorded in a multicentre cohort of 204 incident IPF patients. Based on these dates, the delay was divided into specific patient-related and healthcare-related delays. Demographic and clinical data were used to determine risk factors for a prolonged delay, using multivariate negative binomial regression analysis. Results: The median diagnostic delay was 2.1 years (IQR: 0.9–5.0), mainly attributable to the patients, general practitioners and community hospitals. Male sex was a risk factor for patient delay (IRR: 3.84, 95% CI: 1.17–11.36, p = 0.006) and old age was a risk factor for healthcare delay (IRR: 1.03, 95% CI: 1.01–1.06, p = 0.004). The total delay was prolonged in previous users of inhalation therapy (IRR: 1.99, 95% CI: 1.40–2.88, p < 0.0001) but not in patients with airway obstruction. Misdiagnosis of respiratory symptoms was reported by 41% of all patients.
    [Show full text]
  • A Qualitative Study
    Open Access Research BMJ Open: first published as 10.1136/bmjopen-2016-013648 on 10 March 2017. Downloaded from From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure— a qualitative study C J Taylor,1 F D R Hobbs,1 T Marshall,2 F Leyva-Leon,3 N Gale4 To cite: Taylor CJ, ABSTRACT et al Strengths and limitations of this study Hobbs FDR, Marshall T, . Objectives: To explore 2 key points in the heart From breathless to failure: failure diagnostic pathway—symptom onset and ▪ symptom onset and This study is novel in exploring crucial points in diagnostic meaning—from the patient perspective. diagnostic meaning the heart failure diagnostic pathway from the in patients with heart failure Design: Qualitative interview study. patient perspective to identify areas where care —a qualitative study. BMJ Setting: Participants were recruited from a secondary may be improved. Open 2017;7:e013648. care clinic in central England following referral from ▪ The initial period where participants first experi- doi:10.1136/bmjopen-2016- primary care. enced symptoms, the point they realised there 013648 Participants: Over age 55 years with a recent was something wrong, and the impact this had (<1 year) diagnosis of heart failure confirmed by a on help-seeking is described in detail. ▸ Prepublication history for cardiologist following initial presentation to primary ▪ The terminology of ‘heart failure’, the impact on this paper is available online. care. the patient and the appropriateness of the term To view these files please Methods: Semistructured interviews were carried out itself are questioned. visit the journal online with 16 participants (11 men and 5 women, median ▪ The study recruited participants from a single (http://dx.doi.org/10.1136/ age 78.5 years) in their own homes.
    [Show full text]
  • Determinants of Diagnostic Delay in Chronic Thromboembolic Pulmonary Hypertension: Results from the European CTEPH Registry
    AGORA | RESEARCH LETTER Determinants of diagnostic delay in chronic thromboembolic pulmonary hypertension: results from the European CTEPH Registry To the Editor: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterised by chronic thrombi in the pulmonary arterial bed, causing pulmonary hypertension [1–3]. CTEPH is diagnosed in ∼3% of patients who survive a symptomatic acute pulmonary embolism (PE) [4]. While the surgical removal of chronic fibrotic thrombotic vascular occlusions by pulmonary endarterectomy (PEA) may cure most patients with CTEPH by normalising pulmonary artery haemodynamics and improving symptoms, patients who do not undergo the operation or do not undergo balloon pulmonary angioplasty have severe functional limitations, and poor quality of life and survival [5, 6]. Since the natural course of CTEPH involves progressive remodelling of the distal arteries and increase of pulmonary vascular resistance, which are both important determinants of outcome, early CTEPH diagnosis and referral to an expert centre are both critical for optimal treatment. It has, however, been shown that early diagnosis of CTEPH remains a major challenge, as demonstrated by a median diagnostic delay of 14 months identified in the large European CTEPH Registry [7]. The most likely explanations for this are diagnostic misclassifications as acute PE or other conditions, the nonspecific and often insidious clinical presentation of CTEPH, and the cumbersome diagnostic process of CTEPH, which involves multiple healthcare providers from different clinical specialties [8, 9]. The main determinants for and consequences of the diagnostic delay in CTEPH have not been studied. This was an analysis of the prospective European CTEPH registry that included patients with CTEPH who did not receive PAH-targeted treatment before diagnosis from CTEPH expert centres in Europe and Canada between 2007 and 2009.
    [Show full text]
  • Increase in Tuberculosis Diagnostic Delay During First Wave of the COVID-19 Pandemic: Data from an Italian Infectious Disease Referral Hospital
    antibiotics Article Increase in Tuberculosis Diagnostic Delay during First Wave of the COVID-19 Pandemic: Data from an Italian Infectious Disease Referral Hospital Francesco Di Gennaro 1,* , Gina Gualano 1, Laura Timelli 1, Pietro Vittozzi 1, Virginia Di Bari 1, Raffaella Libertone 1, Carlotta Cerva 1 , Luigi Pinnarelli 2, Carla Nisii 1, Stefania Ianniello 1, Silvia Mosti 1, Nazario Bevilacqua 1, Fabio Iacomi 1, Annalisa Mondi 1, Simone Topino 1, Delia Goletti 1 , Francesco Vaia 1, Giuseppe Ippolito 1 , Enrico Girardi 1 and Fabrizio Palmieri 1 on behalf of the TB-INMI Working Group † 1 National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00161 Rome, Italy; [email protected] (G.G.); [email protected] (L.T.); [email protected] (P.V.); [email protected] (V.D.B.); [email protected] (R.L.); [email protected] (C.C.); [email protected] (C.N.); [email protected] (S.I.); [email protected] (S.M.); [email protected] (N.B.); [email protected] (F.I.); [email protected] (A.M.); [email protected] (S.T.); [email protected] (D.G.); [email protected] (F.V.); [email protected] (G.I.); [email protected] (E.G.); [email protected] (F.P.) 2 Department of Epidemiology of Lazio Regional Health Service, 00147 Rome, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-392-480-4707 † TB-INMI Working Group: Fabrizio Palmieri, Gina Gualano, Andrea Antinori, Nazario Bevilacqua, Maria Capobianchi, Carmine Ciaralli, Gilda
    [Show full text]
  • Patient Related Diagnostic Delay, Symptom Appraisal and Lay
    PATIENT RELATED DIAGNOSTIC DELAY, SYMPTOM APPRAISAL AND LAY CONSULTATION IN HEAD AND NECK CANCER By John Anthony Queenan A thesis submitted to the Department of Public Health Sciences In conformity with the requirements for the degree of Doctor of Philosophy Queen’s University Kingston, Ontario, Canada December, 2014 Copyright ©John Anthony Queenan, 2014 i ABSTRACT The objectives of this thesis were to; 1) identify established risk factors and gaps in the current peer reviewed literature relating to factors associated with patient related diagnostic delay in head and neck cancer, 2) describe and document patients’ personal responses to symptoms of head and neck cancer, the characteristics of the patients’ lay-consultants and the responses that the patients received from their lay-consultants and 3) assess the association between patient/network- related diagnostic delay and a) whether the patient felt any urgency to investigate their symptoms, b) whether the patient told someone in their social network about their symptoms (lay- consultancy) and c) lay-consultant influence. The first manuscript is a scoping review that demonstrates that there is a lack of studies that address; the personal symptom experiences of patients, the psycho-social processes of help- seeking and the independent effects of suspected risk factors for head and neck cancer. The results of the first manuscript also provided me with guidance on what the important confounders of our primary relationship of interest were most likely to be. The second manuscript suggests that patient related delay may be influenced by the patients’ mistaken belief that their symptoms were non-urgent with or without the influence of their lay-consultant.
    [Show full text]