Researchers Probe Factors Behind Higher Mortality Risks in COPD

A pair of abstracts recently presented at CHEST 2020 examined mortality risks arising from complications of chronic obstructive pulmonary disease (COPD).

In one abstract, researchers said their findings about noninvasive home ventilation (NIVH) show that it has been underutilized. NIVH was shown to reduce mortality risks and use of hospital resources significantly among Medicare recipients with chronic respiratory failure as a result of COPD (COPD-CRF).¹

In the investigation, researchers analyzed Medicare claims data from 2012 to 2018 from beneficiaries with COPD-CRF who received NIVH within 2 months post CRF diagnosis and those who had not.

After 1:1 matching, 517 patients with COPD-CRF who received NIVH were compared with 511 patients with COPD-CRF who did not receive NIVH. The mean age of the intervention group was 70.6; they were 44% male and 86% white.

The risk of death for beneficiaries receiving NIVH was reduced by 50% (adjusted hazards ratio [aHR], 0.50; 95% CI, 0.36-0.65; P <.01).

Additionally, the risk of hospitalization was reduced by 28% (aHR, 0.72; 95% CI, 0.52-0.93; P <.01), and the risk of emergency department (ED) visits was cut by 52% (aHR, 0.48; 95% CI 0.38-0.58; P <.01).

A risk difference (RD) of 18% and a relative risk reduction (RRR) of 39.3% were observed for the primary endpoint of overall survival 1 year after receiving a CRF diagnosis. The RD and RRR for hospitalizations were 11.3% and 17%, respectively, after the same amount of time. ED visits had an RD of 20.2% and an RRR of 22% at 1-year post CRF diagnosis.

The number needed to treat at 1 year after receiving a CRF diagnosis were 5.5 to prevent a death, 8.8 to prevent a hospitalization, and 4.9 to prevent and ED visit.

In a second abstract, researchers found that pulmonary hypertension (PH) was associated with higher rates of in-hospital mortality and morbidity in patients with acute exacerbation of COPD (AECOPD) compared with patients who were not diagnosed with PH. ²

Investigators concluded that higher in-hospital mortality and morbidity in patients with AECOPD and PH can lead to greater resource utilization, including hospitalization costs and duration, and can help predict hospital readmission.

Investigators enrolled 821,468 patients with AECOPD, with 68,429 (8.33%) having a diagnosis of PH. PH was commonly associated with female patients (61.1%) with a mean age of 70, being on Medicare (79.5%), more severe morbidity, lower economic status, and treated at urban teaching hospitals.

The study revealed that PH had greater associations of death within a hospital (adjusted odds ratio (aOR) 1.89; 95% CI, 1.73-2.07; P <.01) and a higher rate of 30-day readmissions (aOR 1.24; 95% CI, 1.21-1.28; P <.001) compared with patients without PH.

PH was also found to be related to higher rates of morbidity including intubation rates (aOR, 199; 95% CI, 1.85 -2.14; P <.01), prolonged invasive mechanical ventilation greater lasting longer than 96 hours (aOR 2.12, 95% CI, 1.89-2.38; P <.001), tracheostomy rate (aOR 2.15, 95% CI, 1.53-2.9; P <.001), chest tube placement rate (aOR, 1.39; 95% CI; 1.11-1.74; P <.004), and bronchoscopy rate (aOR, 1.46; 95% CI, 1.11-1.94; P <.007) than participants without a PH diagnosis.

The study also looked at predictors of 30-day readmission rates. Those less likely to be readmitted within 30 days were females, those with private insurance and those who were uninsured but had higher household income.

Predictors of having higher 30-day readmissions were having Medicare insurance, age of 30 to 50 years, a longer hospital stay, more comorbidities, and having a substance use disorder.

Reference

1. van Eijndhoven E, Murphy R, Frazier W. Noninvasive ventilation at home reduces mortality and healthcare utilization in COPD with chronic respiratory failure in Medicare beneficiaries. Presented at: CHEST 2020; October 18-21, 2020.

2. Patel P, Wang Y, Li S, Patel P, Jiyani R. Impact of having pulmonary hypertension in patients admitted with acute exacerbation of COPD in their healthcare utilization and readmission: a us population cohort study. Presented at: CHEST 2020; October 18-21, 2020.