COVER study: Updates from the VERN group

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In March 2020, the Vascular and Endovascular Research Network (VERN) launched the COVID-19 vascular service (COVER) study that is aimed at capturing the impact of the pandemic on global vascular surgery. Over half a year on, co-lead Sandip Nandhra (Newcastle University, Newcastle, UK) gives an update on findings and progress.

VERN is a multidisciplinary research network that aims to advance vascular research through global collaboration. When it became apparent that the worldwide pandemic would heavily impact upon clinical and operative practice, VERN recognised the need to document this impact globally, using high-quality research methodology. We wanted to know how the pandemic would impact on patient care, clinical management, and training.

The COVER study is a global prospective cohort study which used a variety of research methods to address these aims. This collaborative effort involved 251 centres across 53 countries.

The study is split into three tiers, which aimed to: (1) document the changes in vascular service delivery internationally using an online survey (thresholds for treatment, screening, staff redeployment); (2) record all vascular and endovascular interventions performed across a 12-week period during the COVID-19 pandemic and the outcomes following these procedures (in-hospital, short- and long-term) in all participating centres/countries; (3) document changes in how patients were managed during the pandemic when they presented to a vascular surgeon with any type of vascular pathology.

Importantly, the study group recognises the dynamic nature of the pandemic worldwide and adapted quickly to capture additional information when needed. Clinical outcome data from the UK, Europe, and elsewhere have already been analysed and some have been published, with ongoing data capture in other areas of the world (e.g. Brazil) that are currently being affected by the pandemic.

Tier 1 data, recently published in the British Journal of Surgery, highlight a marked reduction in operative work and vascular services offered to patients, such as screening programmes and outpatient clinics. This information is guiding policy decision-making in the UK. Future work will aim to analyse medium- and long-term data for operative and non-operative patients.

Early Tier 2 results are undergoing peer-review: we will shortly report on in-patient mortality for more than 1,200 patients who had vascular procedures during the first wave between April and June 2020. Analysis of Tier 3 data is currently underway and will comprise some of the world’s only data regarding decision-making alterations to vascular care forced by the pandemic related restrictions, policy, and resources with ongoing follow-up. Importantly, COVER follows the VERN collaborative authorship model, with all collaborators named on manuscripts as PubMed citable co-authors and is a methodologically sound prospective cohort study with detailed data collection tools and ethical approvals in place.

Results will help us understand the impact of COVID-19 on vascular service provision, patient management, and outcomes in multiple countries at different stages of the pandemic. These data will be invaluable in informing the development of measures to help mitigate the impact of future peaks and/ or pandemics on patients, staff, and the healthcare service.

Finally, on behalf of the COVER study team and VERN, I would like to thank all of our collaborators and partner organisations across the globe.

The author has no disclosures; the COVER Study was supported by a grant from the Vascular Society of Great Britain and Ireland (VSGBI) and has been adopted onto the National Institute for Health Research (NIHR) portfolio.


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