scholarly journals Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

2015 ◽  
Vol 47 (1) ◽  
pp. 113-121 ◽  
Author(s):  
Sylvia Hartl ◽  
Jose Luis Lopez-Campos ◽  
Francisco Pozo-Rodriguez ◽  
Ady Castro-Acosta ◽  
Michael Studnicka ◽  
...  
Keyword(s):  
Ventilatory Support ◽  
Blood Gases ◽  
Patient Characteristics ◽  
Chronic Obstructive ◽  
Treatment Standards ◽  
Post Discharge ◽  
Factors Associated ◽  
Copd Exacerbations ◽  
Risk Of Death ◽  
Hospital Resources

Studies report high in-hospital and post-discharge mortality of chronic obstructive pulmonary disease (COPD) exacerbations varying depending upon patient characteristics, hospital resources and treatment standards. This study aimed to investigate the patient, resource and organisational factors associated with in-hospital and 90-day post-discharge mortality and readmission of COPD exacerbations within the European COPD Audit. The audit collected data of COPD exacerbation admissions from 13 European countries.On admission, only 49.7% of COPD patients had spirometry results available and only 81.6% had blood gases taken. Using logistic regression analysis, the risk associated with in-hospital and post-discharge mortality was higher age, presence of acidotic respiratory failure, subsequent need for ventilatory support and presence of comorbidity. In addition, the 90-day risk of COPD readmission was associated with previous admissions. Only the number of respiratory specialists per 1000 beds, a variable related to hospital resources, decreased the risk of post-discharge mortality.The European COPD Audit identifies risk factors associated with in-hospital and post-discharge mortality and COPD readmission. Addressing the deficiencies in acute COPD care such as making spirometry available and measuring blood gases and providing noninvasive ventilation more regularly would provide opportunities to improve COPD outcomes.

scholarly journals Management of acute COPD exacerbations in Australia: do we follow the guidelines?

2020 ◽  
Vol 6 (2) ◽  
pp. 00270-2019 ◽  
Author(s):  
Joyce L. Cousins ◽  
Richard Wood-Baker ◽  
Peter A.B. Wark ◽  
Ian A. Yang ◽  
Peter G. Gibson ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Tertiary Care ◽  
Arterial Oxygen Tension ◽  
Blood Gases ◽  
Forced Expiratory Volume ◽  
Arterial Oxygen ◽  
Chronic Obstructive ◽  
Post Discharge ◽  
Copd Exacerbations

ObjectiveWe aimed to assess adherence to the Australian national guideline (COPD-X) against audited practice, and to document the outcomes of patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (COPD) at discharge and 28 days after.MethodsA prospective clinical audit of COPD hospital admission from five tertiary care hospitals in five states of Australia was conducted. Post-discharge follow-up was conducted via telephone to assess for readmission and health status.ResultsThere were 207 admissions for acute exacerbation (171 patients; mean 70.2 years old; 50.3% males). Readmission rates at 28 days were 25.4%, with one (0.6%) death during admission and eight (6.1%) post-discharge within 28 days. Concordance to the COPD-X guidance was variable; 22.7% performed spirometry, 81.1% had blood gases collected when forced expiratory volume in 1 s was <1 L, 99.5% had chest radiography performed, 95.1% were prescribed systemic corticosteroids and 95% were prescribed antibiotic therapy. There were 89.1% given oxygen therapy and 92.6% when arterial oxygen tension was <80 mmHg; 65.6% were given ventilatory assistance when pH was <7.35. Only 32.4% were referred to pulmonary rehabilitation but 76.8% had general practitioner follow-up arranged.ConclusionWhen compared against clinical practice guidelines, we found important gaps in management of patients admitted with COPD throughout tertiary care centres in Australia. Strategies to improve guideline uptake are needed to optimise care.

scholarly journals Ethnicity and other COVID-19 death risk factors in Mexico

2020 ◽  
Author(s):  
Erwin Chiquete ◽  
Jesus Alegre-Díaz ◽  
Ana Ochoa-Guzmán ◽  
Liz Nicole Toapanta-Yanchapaxi ◽  
Carlos González-Carballo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards Model ◽  
Invasive Mechanical Ventilation ◽  
Significant Risk ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Chronic Obstructive ◽  
Death Risk ◽  
Factors Associated ◽  
Risk Of Death

IntroductionPatients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop coronavirus disease 2019 (COVID-19). Risk factors associated with death vary among countries with different ethnic backgrounds. We aimed to describe the factors associated with death in Mexicans with confirmed COVID-19.Material and methodsWe analysed the Mexican Ministry of Health’s official database on people tested for SARS-CoV-2 infection by real-time reverse transcriptase–polymerase chain reaction (rtRT-PCR) of nasopharyngeal fluids. Bivariate analyses were performed to select characteristics potentially associated with death, to integrate a Cox-proportional hazards model.ResultsAs of May 18, 2020, a total of 177,133 persons (90,586 men and 86,551 women) in Mexico received rtRT-PCR testing for SARS-CoV-2. There were 5332 deaths among the 51,633 rtRT-PCR-confirmed cases (10.33%, 95% CI: 10.07–10.59%). The median time (interquartile range, IQR) from symptoms onset to death was nine days (5–13 days), and from hospital admission to death 4 days (2–8 days). The analysis by age groups revealed that the significant risk of death started gradually at the age of 40 years. Independent death risk factors were obesity, hypertension, male sex, indigenous ethnicity, diabetes, chronic kidney disease, immunosuppression, chronic obstructive pulmonary disease, age > 40 years, and the need for invasive mechanical ventilation (IMV). Only 1959 (3.8%) cases received IVM, of whom 1893 were admitted to the intensive care unit (96.6% of those who received IMV).ConclusionsIn Mexico, highly prevalent chronic diseases are risk factors for death among persons with COVID-19. Indigenous ethnicity is a poorly studied factor that needs more investigation.

scholarly journals Anaemia in chronic obstructive pulmonary disease: an insight into its prevalence and pathophysiology

2014 ◽  
Vol 128 (5) ◽  
pp. 283-295 ◽  
Author(s):  
Afroditi K. Boutou ◽  
Nicholas S. Hopkinson ◽  
Michael I. Polkey
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Growth Hormone Level ◽  
Symptom Burden ◽  
Patient Characteristics ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Major Health Problem ◽  
Copd Exacerbations ◽  
Pulmonary Manifestations

Chronic obstructive pulmonary disease (COPD) is a major health problem, with increasing morbidity and mortality. There is a growing literature regarding the extra-pulmonary manifestations of COPD, which can have a significant impact on symptom burden and disease progression. Anaemia is one of the more recently identified co-morbidities, with a prevalence that varies between 4.9% and 38% depending on patient characteristics and the diagnostic criteria used. Systemic inflammation seems to be an important factor for its establishment and repeated bursts of inflammatory mediators during COPD exacerbations could further inhibit erythropoiesis. However, renal impairment, malnutrition, low testosterone levels, growth hormone level abnormalities, oxygen supplementation, theophylline treatment, inhibition of angiotensin-converting enzyme and aging itself are additional factors that could be associated with the development of anaemia. The present review evaluates the published literature on the prevalence and significance of anaemia in COPD. Moreover, it attempts to elucidate the reasons for the high variability reported and investigates the complex pathophysiology underlying the development of anaemia in these patients.

Abstract 18893: ADP Receptor Inhibitor Therapy Use Beyond 12 Months in Community Practice: Results From the Translate-ACS Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jonathan D Hansen ◽  
Lisa A McCoy ◽  
David J Cohen ◽  
Timothy D Henry ◽  
Gregg Fonarow ◽  
...  
Keyword(s):  
Coronary Revascularization ◽  
Patient Characteristics ◽  
Coronary Intervention ◽  
Community Practice ◽  
Post Discharge ◽  
Factors Associated ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Adp Receptor ◽  
Using Data

Background: Prolonged use of ADP receptor inhibitors (ADPri) beyond 1 year following myocardial infarction (MI) and percutaneous coronary intervention (PCI) is supported by recent studies such as DAPT and PEGASUS. In community practice, how often and in which patients prolonged ADPri therapy is used is poorly understood. Methods: Using data from the TRANSLATE-ACS observational study, we examined prevalence of ADPri continuation beyond 1 year post-MI in routine US practice (2010-2012) and used multivariable logistic regression to identify patient characteristics associated with ADPri use beyond 1 year. Results: Of 8,749 patients alive and still on ADPri at 12 months post-MI, 6,627 (76%) were still on ADPri at the 15-month interview. ADPri use beyond 1 year occurred more frequently among black vs. white patients (82.7% vs. 75.1%), patients with prior PCI (85.4% vs. 73.2%) or prior CABG (87.0% vs. 74.5%), and those with multivessel disease (78.8% vs. 72.7%, p<0.001 for all). Use of drug eluting stents did not affect likelihood of prolonged ADPri use, 77% in both groups (p= 0.98). Patients discharged on prasugrel/ticagrelor were less likely to continue their ADPri beyond 1 year than those discharged on clopidogrel (71.1% vs. 77.9%, p<0.001). Unplanned coronary revascularization occurred more commonly within the first 1 year post-MI among patients who continued on ADPri beyond 1 year (14.3% vs. 4.6%, p<0.001), but the rate of BARC 2+ bleeding was lower (19.9% vs. 22.3%, p=0.02) than those who stopped ADPri at 1 year. These variables remained independent factors associated with post-1 year ADPri continuation in multivariable modeling (Figure). Conclusion: In routine US practice, the majority of MI patients who underwent PCI were already receiving prolonged ADPri therapy beyond 1 year even before DAPT and PEGASUS trials. Post-discharge unplanned revascularization and bleeding appear to be the strongest predictors for and against prolonged ADPri use, respectively.

A Multidisciplinary Intervention to Improve Care for High-Risk COPD Patients

2019 ◽  
Vol 35 (3) ◽  
pp. 231-235 ◽  
Author(s):  
Elizabeth Gay ◽  
Sonali Desai ◽  
Debra McNeil
Keyword(s):  
High Risk ◽  
Emergency Department Visits ◽  
Patient Navigator ◽  
Chronic Obstructive ◽  
Community Partner ◽  
Post Discharge ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Phone Calls ◽  
Copd Patients

Chronic obstructive pulmonary disease (COPD) exacerbations contribute to both costs and patient morbidity. The authors designed a quality project to improve care for high-risk COPD patients admitted with an exacerbation. An electronic medical record report was used to target admitted high-risk COPD patients for an intervention that included pulmonary and respiratory therapy consults, post-discharge phone calls from a patient navigator, referrals to palliative services when appropriate, and bedside delivery of medications. The control population was a similar group of patients at a community partner hospital who received usual care. In all, 157 unique patients were enrolled over 16 months; referrals to palliative care services increased and rates of outpatient follow-up improved. There was no difference in readmissions or emergency department visits between the 2 groups. Better coordination of outpatient care and attention to psychosocial burdens were identified as possible targets for future interventions.

scholarly journals Serum biomarkers and outcomes in patients with moderate COPD: a substudy of the randomised SUMMIT trial

2019 ◽  
Vol 6 (1) ◽  
pp. e000431 ◽  
Author(s):  
Bartolome R Celli ◽  
Julie A Anderson ◽  
Robert Brook ◽  
Peter Calverley ◽  
Nicholas J Cowans ◽  
...  
Keyword(s):  
Surfactant Protein ◽  
Forced Expiratory Volume ◽  
Cell Protein ◽  
Surfactant Protein D ◽  
Chronic Obstructive ◽  
Mortality And Morbidity ◽  
Copd Exacerbations ◽  
Club Cell ◽  
Risk Of Death ◽  
Increased Risk

RationaleSystemic levels of C reactive protein (CRP), surfactant protein D (SPD), fibrinogen, soluble receptor of activated glycogen end-product (sRAGE) and club cell protein 16 (CC-16) have been associated with chronic obstructive pulmonary disease (COPD) outcomes. However, they require validation in different cohorts.ObjectivesRelate systemic levels of those proteins to forced expiratory volume in 1 s (FEV1) decline, exacerbations, hospitalisations and mortality in COPD patients (FEV1 of ≥50 and ≤70% predicted) and heightened cardiovascular risk in a substudy of the Study to Understand Mortality and MorbidITy trial.MethodsParticipants were randomised to daily inhalations of placebo, vilanterol 25 µg (VI), fluticasone furoate 100 µg (FF) or their combination (VI 25/FF 100) and followed quarterly until 1000 deaths in the overall 16 485 participants occurred. Biomarker blood samples were available from 1673 patients. The FEV1 decline (mL/year), COPD exacerbations, hospitalisations and death were determined. Associations between biomarker levels and outcomes were adjusted by age and gender.ResultsSystemic levels of CC-16, CRP, sRAGE, SPD and fibrinogen did not relate to baseline FEV1, FEV1 decline, exacerbations or hospitalisations. Fibrinogen and CRP were related to mortality over a median follow-up of 2.3 years. Only the CC-16 changed with study therapy (VI, FF and FF/VI, p<0.01) at 3 months.ConclusionsIn COPD, systemic levels of CC-16, CRP, sRAGE, SPD and fibrinogen were not associated with FEV1 decline, exacerbations or hospitalisations. These results cast doubts about the clinical usefulness of the systemic levels of these proteins as surrogate markers of these COPD outcomes. The study confirms that CRP and fibrinogen are associated with increased risk of death in patients with COPD.Trial registration numberNCT01313676.

Abstract P098: Is There a Mismatch Between Length of Hospital Stay and Prognosis in Medicare Beneficiaries Hospitalized for Heart Failure?

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Matthew S Loop ◽  
Melissa K Van Dyke ◽  
Ligong Chen ◽  
Todd M Brown ◽  
Raegan W Durant ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Medicare Beneficiaries ◽  
Post Discharge ◽  
Discharge Disposition ◽  
Risk Of Death ◽  
Comorbidity Burden

Background: Length of stay (LOS) during heart failure (HF) hospitalizations has decreased, accompanied by recent increases in post-discharge mortality and 30-day readmission rates among these patients. Methods: We conducted a retrospective cohort study of 19,477 Medicare beneficiaries in order to determine whether patients with the longest LOS also had the highest risk of death or readmission. We included patients hospitalized for HF and discharged alive between 2007 and 2011 with documented left ventricular (LV) systolic, diastolic, or combined dysfunction. We estimated the associations of LOS, risk for 30-day mortality, and risk for 30-day readmission with: type of LV dysfunction, HF severity, comorbidity burden, discharge disposition, demographics, nursing home residence, and calendar year. Gamma regression, Poisson regression, and Cox proportional hazards were used to model LOS, 30-day mortality, and 30-day readmission, respectively. Each model included all covariates. Results: The mean (IQR) LOS was 5 (4 - 8) days, 7% of the patients died within 30 days, and 23% of the patients were readmitted within 30 days. Patients with isolated diastolic dysfunction (DD) had 2% shorter LOS than patients with any systolic dysfunction (SD), but had 10% lower 30-day mortality. Comorbidities were associated with a 3% to 10% longer LOS, with the exception of chronic kidney disease (CKD) (16% longer) and malnutrition (30% longer). Only CKD, malnutrition, and chronic obstructive pulmonary disease (COPD) were associated with 30-day mortality (22%, 51%, and 14% higher risk, respectively). Most comorbidities were associated with 10% - 20% higher risk of 30-day readmission. Regarding discharge disposition, patients discharged home had 40% shorter LOS, 78% lower 30-day mortality, and 11% lower risk for 30-day readmission than patients discharged to a skilled nursing facility (SNF). Conclusions: We found no mismatch between LOS and prognosis among Medicare beneficiaries hospitalized for HF.

scholarly journals Effect of COVID-19-Related Lockdown οn Hospital Admissions for Asthma and COPD Exacerbations: Associations with Air Pollution and Patient Characteristics

2021 ◽  
Vol 11 (9) ◽  
pp. 867
Author(s):  
Ioanna Sigala ◽  
Timoleon Giannakas ◽  
Vassilis G. Giannakoulis ◽  
Efthimios Zervas ◽  
Aikaterini Brinia ◽  
...  
Keyword(s):  
Air Pollution ◽  
Particulate Matter ◽  
Air Pollutants ◽  
Hospital Admissions ◽  
Nitrogen Monoxide ◽  
Patient Characteristics ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations

We conducted a retrospective observational study to assess the hospitalization rates for acute exacerbations of asthma and COPD (chronic obstructive pulmonary disease) during the first imposed lockdown in Athens, Greece. Patient characteristics and the concentration of eight air pollutants [namely, NO (nitrogen monoxide), NO2 (nitrogen dioxide), CO (carbon monoxide), PM2.5 (particulate matter 2.5), PM10 (particulate matter 10), O3 (ozone), SO2 (sulfur dioxide) and benzene] were considered. A total of 153 consecutive hospital admissions were studied. Reduced admissions occurred in the Lockdown period compared to the Pre-lockdown 2020 (p < 0.001) or the Control 2019 (p = 0.007) period. Furthermore, the concentration of 6/8 air pollutants positively correlated with weekly hospital admissions in 2020 and significantly decreased during the lockdown. Finally, admitted patients for asthma exacerbation during the lockdown were younger (p = 0.046) and less frequently presented respiratory failure (p = 0.038), whereas patients with COPD presented higher blood eosinophil percentage (p = 0.017) and count (p = 0.012). Overall, admissions for asthma and COPD exacerbations decreased during the lockdown. This might be partially explained by reduction of air pollution during this period while medical care avoidance behavior, especially among elderly patients cannot be excluded. Our findings aid in understanding the untold impact of the pandemic on diseases beyond COVID-19, focusing on patients with obstructive diseases.

Frequent emergency attenders: is there a better way?

2011 ◽  
Vol 35 (4) ◽  
pp. 462 ◽  
Author(s):  
Sue E. Kirby ◽  
Sarah M. Dennis ◽  
Upali W. Jayasinghe ◽  
Mark F. Harris
Keyword(s):  
Emergency Department ◽  
Community Mental Health Services ◽  
Patient Characteristics ◽  
Chronic Obstructive ◽  
Hospital Data ◽  
Service Usage ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Repeat Prescriptions

Background. Understanding the reasons for frequent re-attendances will assist in developing solutions to hospital overcrowding. This study aimed to identify the factors associated with frequent re-attendances in a regional hospital thereby highlighting possible solutions to the problem. Methods. A retrospective analysis was performed on emergency department data from 2008. Frequent re-attenders were defined as those with four or more presentations in a year. Clinical, service usage and demographic patient characteristics were examined for their influence on re-presentations using multivariate analysis. Results. A total of 8% of the total patients presenting to emergency re-attended four or more times in the year. Frequent re-attenders were older, presented with an unplanned returned visit and had a diagnosis of neurosis, chronic obstructive pulmonary disease (COPD), convulsions, dyspnoea or repeat prescriptions, follow-up examinations or dressings and sutures and less likely to present in summer. Frequent re-attendances were unrelated to sex, time of presentation or country of birth. Conclusions. Diversion of patients with minor conditions to alternative services; referral of COPD patients to follow-up respiratory services and patients with neurosis to community mental health services would reduce emergency utilisation. Improving access to and resourcing of alternative non-hospital services should be investigated to reduce emergency overcrowding. What is known about the topic? Frequent re-attendances at emergency contribute to emergency overcrowding and are a problem worldwide. Generally, frequent re-attendances have been associated with disadvantage. Identifying patient factors that predict re-attendances will assist in developing strategies to prevent their occurrence. The reasons for re-attendances may vary depending on access to other services and the role of the hospital. What does this paper add? This paper adds to the field by demonstrating how routinely collected hospital data can be used to determine patient characteristics important in frequent re-attendances. The factors associated with frequently re-attending patients include older age, type of condition, unplanned return visit and season. What are the implications for practitioners? This paper has implications for both administrators and clinicians. The diversion of attending patients with neurosis, COPD, dyspnoea or repeat prescriptions, follow-up examinations or dressings and sutures to alternative affordable and accessible services would reduce overcrowding in the emergency department.

The Probability of A1C Goal Attainment in Patients with Uncontrolled Type-2 Diabetes in a Large Integrated Delivery System: A Prediction Model

2020 ◽  
Author(s):  
Kevin M Pantalone ◽  
Anita D Misra-Hebert ◽  
Todd M Hobbs ◽  
Sheldon X Kong ◽  
Xinge Ji ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Goal Attainment ◽  
Index Date ◽  
Cleveland Clinic ◽  
Patient Characteristics ◽  
Psychiatric Disease ◽  
Lower Probability ◽  
Factors Associated ◽  
One Year

<b>Objective:</b> To assess patient characteristics and treatment factors associated with uncontrolled type 2 diabetes (T2D) and the probability of A1C goal attainment. <p><b>Research Design and Methods</b>: Retrospective cohort study using the electronic health record at Cleveland Clinic. Patients with uncontrolled T2D (A1C>9%) were identified on the index date of 12/31/2016 (n=6,973), grouped by attainment (n=1,653 [24.7%) or non-attainment (n=5,320 [76.3%]) of A1C<8% by 12/31/2017, and subgroups compared on a number of demographic and clinical variables. Based on these variables, a nomogram was created for predicting probability of A1C goal attainment. </p> <p><b>Results:</b> For the entire population, median age at index date was 57.7 years (53.3% male), and the majority were white (67.2%). Median A1C was 10.2%. Obesity (50.6%), cardiovascular disease (46.9%) and psychiatric disease (61.1%) were the most common comorbidities. Metformin (62.7%) and sulfonylureas (38.7%) were the most common anti-diabetes medications. Only 1,653 (24%) patients achieved an A1C <8%. Predictors of increased probability of A1C goal attainment were older age, white/non-Hispanic race/ethnicity, Medicare health insurance, lower baseline A1C, higher frequency of endocrinology/primary care visits, DPP-4i use, thiazolidinedione use, metformin use, GLP-1RA use, and fewer classes of anti-diabetes drugs. Factors associated with lower probability included insulin use and longer time in the T2D database (both presumed as likely surrogates for duration of T2D). </p> <p><b>Conclusions:</b> A minority of patients with an A1C>9% achieved an A1C<8% at one year. While most identified predictive factors are non-modifiable by the clinician, pursuit of frequent patient engagement and tailored drug regimens may help improve A1C goal attainment. </p>

Sign in / Sign up

Export Citation Format

Share Document