Functional status at discharge and 30-day readmission risk in COPD

Nguyen, Huong Q.; Rondinelli, June; Harrington, Annie; Desai, Smita; Liu, In Liu Amy; Lee, Janet; Gould, Michael K.

doi:10.1016/j.rmed.2014.12.004

Cited by 25 publications

(36 citation statements)

References 38 publications

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“…The risk of readmission increased with a greater number of previous emergency [19,32]. Previous COPD and non-COPD hospitalisations in the previous year also significantly increased the risk for 30-day readmission by 53% to 56% and 60% to 64%, respectively [38,39]. Consistent with other studies, GOTO et al [31] found that frequent exacerbators (defined as two hospitalisations in the past year) BOTTLE [21] GERSHON [32] GOTO [31] JACOBS [35] SHARIF [44] SIMMERING [45] TZY-CHYI YU [48] Overall (I 2 =95.4%, p=0.000) had a 2.5-fold increase in odds of readmission compared to non-frequent exacerbators.…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

et al. 2020

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BackgroundReadmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD.MethodsWe systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle–Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model.ResultsIn total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8–26.0% at 30 days and from 17.5–39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22–1.37)), renal failure (1.26 (1.19–1.33)), depression (1.19 (1.05–1.34)) and alcohol use (1.11 (1.07–1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88–0.94)).ConclusionsComorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.

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Section: Meta-analysis Resultsmentioning

confidence: 99%

Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

et al. 2020

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“…Engagement in physical activity is a modifiable health behavior that affects COPD specific health outcomes independent of lung function 7374757677787980. People with COPD who have a high daily step count are at lower risk of dying than those with a low daily step count even after controlling for lung function (FEV 1 ) 747576.…”

Section: Chronic Obstructive Pulmonary Disease and Pulmonary Rehabilimentioning

confidence: 99%

“…An observational cohort study of 169 people with COPD who wore an accelerometer showed that those who were the least physically active had double the risk of acute exacerbations and six times the risk of hospital admission over a median follow-up of 16 months compared with those who walked the most 77. Patients who reported any moderate to vigorous physical activity (MVPA) had a lower risk of 30-day hospital readmission after an index admission for COPD compared with those who reported no MVPA 78. These studies of daily step count support the notion that every step walked can positively affect COPD outcomes.…”

Section: Chronic Obstructive Pulmonary Disease and Pulmonary Rehabilimentioning

confidence: 99%

Advances in rehabilitation for chronic diseases: improving health outcomes and function

Richardson

Franklin

Moy

et al. 2019

BMJ

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Much of the burden on healthcare systems is related to the management of chronic conditions such as cardiovascular disease and chronic obstructive pulmonary disease. Although conventional outpatient cardiopulmonary rehabilitation programs significantly decrease morbidity and mortality and improve function and health related quality of life for people with chronic diseases, rehabilitation programs are underused. Barriers to enrollment are multifactorial and include failure to recommend and refer patients to these services; poor communication with patients about potential benefits; and patient factors including logistical and financial barriers, comorbidities, and competing demands that make participation in facility based programs difficult. Recent advances in rehabilitation programs that involve remotely delivered technology could help deliver services to more people who might benefit. Problems with intensity, adherence, and safety of home based programs have been investigated in recent clinical trials, and larger dissemination and implementation trials are under way. This review summarizes the evidence for benefit of in-person cardiac and pulmonary rehabilitation programs. It also reviews the literature on newer developments, such as home based remotely mediated exercise programs developed to decrease cost and improve accessibility, high intensity interval training in cardiac rehabilitation, and alternative therapies such as tai chi and yoga for people with chronic obstructive pulmonary disease.

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“…The relationship between exacerbations of COPD and physical activity is complex and currently not well understood. Low activity levels are a strong predictor of future severe exacerbations; 6 – 10 however, physical activity is also known to be reduced during exacerbations. 11 – 13 Exacerbations are characterized by a worsening of the patient’s respiratory symptoms beyond the normal day-today variability; 14 however, there are a few studies published on exacerbation symptoms in relation to physical activity.…”

Section: Introductionmentioning

confidence: 99%

The association between daily exacerbation symptoms and physical activity in patients with chronic obstructive pulmonary disease

Crook

Büsching²,

Keusch³

et al. 2018

COPD

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BackgroundEvidence from longitudinal studies on the impact of exacerbation symptoms on physical activity in chronic obstructive pulmonary disease (COPD) is lacking. The aim of this first exploratory study was to assess the association between exacerbation symptoms and physical activity, and to quantify the relative influence of specific symptoms.MethodsWe recruited COPD patients at high risk for exacerbations from 2 pulmonary rehabilitation clinics and 1 acute care clinic in Switzerland. For 3 months after discharge, patients completed a daily symptom diary on a smartphone application, the EXAcerbations of Chronic pulmonary disease Tool (EXACT), and wore a pedometer to measure daily steps. We used mixed-effects models to determine the association of daily steps with exacerbation symptoms.ResultsA total of 21 patients (Global Initiative for Chronic Obstructive Lung Disease grades 2–4) were enrolled for a mean of 94.4 days (standard deviation 4.2). The baseline median number of daily steps was 3,264.6 (interquartile range [IQR]: 1,851.3–4,784.1) and EXACT score was 37.0 (IQR: 30.9–41.4). A 12-point increase in EXACT score (indicating the start of an exacerbation) was statistically significantly associated with a decrease in daily steps of 653.3 (95% CI 969.7–336.9). Chest symptoms (tightness, discomfort and congestion) were more strongly associated with change in steps than breathlessness, and cough and sputum (z-value −4.5 vs −2.9 and −3.0).ConclusionThis is the first study to show that, in a small cohort of COPD patients, increases in exacerbation symptoms were associated with a statistically and clinically significant reduction in daily physical activity. These results underscore the importance for symptom control and exacerbation prevention in COPD patients.

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Functional status at discharge and 30-day readmission risk in COPD

Abstract: Patients with COPD who were non-ambulatory within 24 h prior to discharge were at significantly greater risk of readmission compared to ambulatory patients. Functional status should be used to risk stratify patients for more intensive supportive interventions post discharge.

Cited by 25 publications

References 38 publications

Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

Advances in rehabilitation for chronic diseases: improving health outcomes and function

The association between daily exacerbation symptoms and physical activity in patients with chronic obstructive pulmonary disease

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