Prediction of five-year mortality after COPD diagnosis using primary care records

Abstract

Accurate prognosis information after a diagnosis of chronic obstructive pulmonary disease (COPD) would facilitate earlier and better informed decisions about the use of prevention strategies and advanced care plans. We therefore aimed to develop and validate an accurate prognosis model for incident COPD cases using only information present in general practitioner (GP) records at the point of diagnosis. Incident COPD patients between 2004–2012 over the age of 35 were studied using records from 396 general practices in England. We developed a model to predict all-cause five-year mortality at the point of COPD diagnosis, using 47,964 English patients. Our model uses age, gender, smoking status, body mass index, forced expiratory volume in 1-second (FEV1) % predicted and 16 co-morbidities (the same number as the Charlson Co-morbidity Index). The performance of our chosen model was validated in all countries of the UK (N = 48,304). Our model performed well, and performed consistently in validation data. The validation area under the curves in each country varied between 0.783–0.809 and the calibration slopes between 0.911–1.04. Our model performed better in this context than models based on the Charlson Co-morbidity Index or Cambridge Multimorbidity Score. We have developed and validated a model that outperforms general multimorbidity scores at predicting five-year mortality after COPD diagnosis. Our model includes only data routinely collected before COPD diagnosis, allowing it to be readily translated into clinical practice, and has been made available through an online risk calculator ( https://skiddle.shinyapps.io/incidentcopdsurvival/ ).

Development and validation of a multivariable mortality risk prediction model for COPD in primary care

“…These studies, however, did not take individual co-morbidities into account, a limitation as corroborated by Aramburu et al 28 who found that the prognostic capacity of the existing risk scores improves when co-morbidity information is added but recommended that there is a need for further studies to clarify which co-morbidities need to be taken into account. Consequently, two recent large-scale studies 9 , 10 , have attempted to develop a mortality prediction model that use routinely available data in primary care in the UK including various individual co-morbidities. However, neither of these studies accounted for any co-morbidity diagnosed after COPD diagnosis, and the model is therefore only relevant to risk-stratify patients at the time (or near the time) of COPD diagnosis.…”

“…Consequently, a few studies have developed separate prognostic models to predict mortality in COPD patients (see Supplementary information). However, with the exception of two recent studies 9 , 10 , these existing studies are based on limited numbers of patients, have short follow-up periods and are typically from a single centre.…”

Respiratory-related death in individuals with incident asthma and COPD: a competing risk analysis

“…Furthermore, there are increased opportunities to misdiagnose COPD for example as heart failure, as both conditions are systemic disorders with overlapping pathophysiological processes [ 30 , 31 ], and coexistence of both diseases has been shown to increase mortality risk [ 32 ]. This study provides further evidence that COPD is associated with a high respiratory-related mortality burden despite the widespread availability and routine use of disease management interventions such as pulmonary rehabilitation, smoking cessation programmes, use of prognostic risk calculators [ 33 ] partnered with targeted therapeutics.…”

Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST quality standards: an observational longitudinal study

“… 5 , 6 Delayed diagnosis and under-treatment of COPD results in a significantly higher risk of exacerbations and hospitalisation, 7 which are themselves associated with poor long-term outcomes and death. Comorbidities, particularly cardiac disease, are associated with increased mortality in COPD 8 and assessment and management of these conditions is also essential to improve long term outcomes.…”