International Journal of COPD (Oct 2020)
Management and Risk of Mortality in Patients Hospitalised Due to a First Severe COPD Exacerbation
Abstract
Christer Janson,1 Bright I Nwaru,2,3 Fredrik Wiklund,4 Gunilla Telg,5 Magnus Ekström6 1Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden; 2Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; 3Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; 4Statisticon AB, Uppsala, Sweden; 5AstraZeneca Nordic-Baltic, Södertälje, Sweden; 6Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, SwedenCorrespondence: Christer JansonDepartment of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Akademiska Sjukhuset, Uppsala 751 85, SwedenTel +4618-6114115Email [email protected]: Reducing the need for hospitalisation in patients with chronic obstructive pulmonary disease (COPD) is an important goal in COPD management. The aim of this study was to evaluate re-hospitalisation, treatment, comorbidities and mortality in patients with COPD who were hospitalised for the first time due to a COPD exacerbation.Methods: This was a retrospective, population-based observational cohort study of Swedish patients using linked data from three mandatory national health registries to assess re-hospitalisation rates, medication use and mortality. Rate of hospitalisation was calculated using the number of events divided by the number of person-years at risk; risk of all-cause and COPD-related mortality were assessed using Cox proportional hazard models.Results: In total, 51,247 patients were identified over 10 years; 35% of patients were not using inhaled corticosteroid, long-acting muscarinic antagonist or long-acting β2-agonist treatment prior to hospitalisation, 38% of whom continued without treatment after being discharged. Re-hospitalisation due to a second severe exacerbation occurred in 11.5%, 17.8% and 24% of the patients within 30, 90 and 365 days, respectively. Furthermore, 24% died during the first year following hospitalisation and risk of all-cause and COPD-related mortality increased with every subsequent re-hospitalisation. Comorbidities, including ischaemic heart disease, heart failure and pneumonia, were more common amongst patients who were re-hospitalised than those who were not.Conclusion: Following hospitalisation for first severe COPD exacerbation, many patients did not collect the treatment recommended by current guidelines. Risk of mortality increased with every subsequent re-hospitalisation. Patients with concurrent comorbidities had an increased risk of being re-hospitalised.Keywords: COPD, re-hospitalisation, management, mortality
