60. Trends in Hospital Admissions in People with ANCA-associated Vasculitis Before and During the COVID19 Pandemic
Creators: name: Myron Odingo1, 3
name: Megan Rutter1,2,3
name: Peter C.  Lanyon1,2,3
name: Grainge1, Matthew J.
name: David J.  Groves1, 3
name: Bythell3, Mary
name: Aston3, Jeanette
name: Stevens3, Sarah
name: Fiona A. Pearce1,2,3
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background/ Objectives: </strong>People with ANCA-associated vasculitis (AAV) have high rates of hospital admissions for their vasculitis. They may have emergency admissions at the time of diagnosis, or day case admissions to receive immunosuppressive treatment. We describe the trends in emergency and day case admissions over the past 9 years, and the effect of the COVID-19 pandemic. <strong>Methods:</strong> We extracted Hospital Episode Statistics data for the financial years 2012/13 to 2019/20, publicly available from NHS Digital, and supplemented these with provisional data for 2020/21 from the National Congenital Anomaly and Rare Disease Registration Service, using their legal permissions (CAG 10-02(d)/2015) because the publicly available data had not been released yet. We extracted all emergency and day case admission rates with ICD-10 codes for each AAV subtype: granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (M313, M317 and M303 respectively), in the primary position denoting main admission diagnosis. We used England population estimates from the Office for National Statistics as the denominator for rates. We calculated Poisson confidence intervals to quantify the difference in rates across the financial years between 2012/13 and 2020/21. <strong>Results:</strong> Rates of day case admissions per 1,000,000 for AAV increased from 49.1 (95% CI 47.2 - 50.9) in 2012/13 to 63.3 (95% CI 61.2 - 65.4) in 2019/20, then decreased by 26.4% to 48.6 (95% CI 46.7 - 50.4) in 2020/21 (see table). The trends in emergency admissions were relatively unchanged between 2012/13 and 2019/20 (mean 6.7 per 1,000,000), and there was no significant decrease in emergency admissions during the COVID-19 pandemic in financial year 2020/21. <strong>Conclusions:</strong> Day case admission rates increased between 2012/13 and 2019/20 but decreased during the COVID-19 pandemic. Emergency admission rates for people with AAV remained relatively unchanged, despite the context of the significant disruption and reconfiguration of healthcare services. Further research using patient-level data is needed to establish whether the reduction in day case activity is due to fewer people being diagnosed with new or relapsing disease, and therefore fewer remission induction infusions being administered, or due to postponement of planned remission maintenance treatment due to perceived risk from COVID-19 infection. Alternatively, the reduction in day case admissions may reflect a change in clinical practice to preferentially use oral rather than IV agents. All of these changes in healthcare delivery may have future consequences both for clinical practice and individual patient care and outcomes post-pandemic. <strong>Disclosures:</strong> P. Lanyon: received funding for research from Vifor Pharma. FAP has received funding for research from Vifor Pharma.