Impact of pulmonary hypertension in patients with acute exacerbation of chronic obstructive pulmonary disease and its effect on healthcare utilization

Abstract

We aim to study the impact of pulmonary hypertension (PH) on acutely exacerbated chronic obstructive pulmonary disease (AECOPD). We used the 2016 and 2017 National Readmission Database with an inclusion criterion of AECOPD as a primary and PH as a secondary diagnosis using ICD 10-CM codes. Exclusion criteria were age under 18 years, non-elective admission, and discharge in December. The primary outcome was in-hospital mortality during the index admission. Secondary outcomes were 30-day readmission rate, resource utilization, and instrument utilization including intubation, prolonged invasive mechanical ventilation >96hr (PIMV), tracheostomy, chest tube placement, and bronchoscopy during the index admission. A total of 627,848 patients with AECOPD were included in the study, and 68,429 (10.90 %) patients had a diagnosis of PH. PH was more common among females (61.14%) with a mean age of 71 ±11.66, Medicare recipients (79.5%), higher Charlson Comorbidity Index, and treatment in an urban teaching hospital. PH was associated with greater mortality [adjusted odds ratio (aOR): 1.89, p<0.001], higher 30-day readmission (aOR-1.24, p<0.001), higher cost [adjusted mean difference (aMD: $2785, p<0.01], LOS (aMD-1.09, p<0.001) and higher instrument utilization including intubation (aOR: 199, p<0.001), PIMV (aOR: 2.12, p<0.001), tracheostomy (aOR-2.1, p<0.001), bronchoscopy (aOR-1.46, p=0.007) and chest tube placement (aOR-1.39 p<0.004). We found that PH is related to higher in-hospital mortality, LOS, increased instrument utilization, readmission, and costs. Our study aims to shed light on the impact of PH on AECOPD in hopes to improve future management.

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…123 Among ≈600 000 Medicare patients with acute exacerbated COPD, secondary PH diagnosis was present in 10.9%. 124 WHO group 4 PH (CTEPH and other pulmonary obstructions): prevalence ranges from 1.0% to 8.8% among those with PE. 123 CTEPH incidence, however, may be underestimated according to general population data; in a 2017 modeling study, only 7% to 29% of CTEPH cases were diagnosed.…”

“…In PH group 3, patients with PH and lung disease had an increased in-hospital mortality compared with those with no PH (OR, 1.89 [95% CI, 1.73–2.07]). 124…”

“…In patients of WHO group 3 PH, there is an increase in hospitalization costs of $2785 (mean difference [95% CI, $2602–$2967]). 124…”

“…123 Among ≈600 000 Medicare patients with acute exacerbated COPD, secondary PH diagnosis was present in 10.9%. 124…”

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…Among ≈600 000 Medicare patients admitted with acute exacerbated chronic obstructive pulmonary disease, secondary PH diagnosis was present in 10.9%. 127…”