Prognostic factors after hospitalization for COPD exacerbation

Fuhrman, C.; Moutengou, E.; Roche, N.; Delmas, Marie-Christine

doi:10.1016/j.rmr.2016.03.012

Cited by 9 publications

(20 citation statements)

References 30 publications

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“…The 12-month mortality rate was significantly and markedly lower in the DM group (1.9%) than in the UM group (14.2%), the latter of which is consistent with, or lower than, the 12-month mortality rates of 12.5% [28], 16.8% [29], 21% [30] and >23% [31] that have been reported previously for COPD patients following a hospitalisation for an acute exacerbation of COPD. That mortality was lower than expected in the DM group, rather than excessively high in the UM group, suggests that the disease management intervention reduced mortality.…”

Section: Discussionsupporting

confidence: 89%

COMET: a multicomponent home-based disease-management programmeversusroutine care in severe COPD

et al. 2018

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The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients.The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s <50% of predicted value) randomised 1:1 to the disease management intervention or to the usual management practices at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management. The primary end-point was the number of unplanned all-cause hospitalisation days in the intention-to-treat (ITT) population. Secondary end-points included acute care hospitalisation days, BODE (body mass index, airflow obstruction, dyspnoea and exercise) index and exacerbations. Safety end-points included adverse events and deaths.For the 157 (disease management) and 162 (usual management) patients eligible for ITT analyses, all-cause hospitalisation days per year (mean±sd) were 17.4±35.4 and 22.6±41.8, respectively (mean difference -5.3, 95% CI -13.7 to -3.1; p=0.16). The disease management group had fewer per-protocol acute care hospitalisation days per year (p=0.047), a lower BODE index (p=0.01) and a lower mortality rate (1.9% 14.2%; p<0.001), with no difference in exacerbation frequency. Patient profiles and hospitalisation practices varied substantially across countries.The COMET disease management intervention did not significantly reduce unplanned all-cause hospitalisation days, but reduced acute care hospitalisation days and mortality in severe COPD patients.

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Section: Discussionsupporting

confidence: 89%

COMET: a multicomponent home-based disease-management programmeversusroutine care in severe COPD

et al. 2018

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“…Length of stay was shorter in the PRADO group but remains higher than the average one in UK22 and Canada 29. It is similar to the usual French inpatient stay duration for AECOPD, 9.9 days,6 illustrating another French paradox, as this longer inpatient stay could explain a lower readmission rate 18…”

Section: Discussionmentioning

confidence: 58%

“…Indeed, in our population, patients in the control group were more likely to receive diuretics when compared with the PRADO group, emphasizing a different clinical presentation. Several prognostic factors for readmission have been developed,13,15,18 as well as noninvasive physiological assessment 16,28. These tools need to be evaluated to identify patients at high risk for readmission, who are more likely to benefit from a home discharge care bundle.…”

Section: Discussionmentioning

confidence: 99%

“…However, none of the analyzed studies was conducted in France and with the specific French Health Care Organization. Notably, 28-days readmission rate of exacerbated COPD patients is low in France (7.2%),18 when compared with that in UK (20%) 19…”

Section: Introductionmentioning

confidence: 99%

“…Strategies to identify patients at risk have been developed1,13–16 and discharge care bundles have sometimes been set at a national level. A meta-analysis showed that discharge care bundle may reduce hospital readmission with a risk ratio of 0.80 18. However, none of the analyzed studies was conducted in France and with the specific French Health Care Organization.…”

Section: Introductionmentioning

confidence: 99%

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<p>Efficacy of a home discharge care bundle after acute exacerbation of COPD</p>

Cousse¹,

Gillibert²,

Thiberville³

et al. 2019

COPD

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PurposeAcute exacerbations of COPD (AECOPD) are frequent and associated with a poor prognosis. A home discharge care bundle, the PRADO-BPCO program, has been set up by the French National Health System in order to reduce readmission rate after hospitalization for AECOPD. This program includes early consultations by the general practitioner, a nurse, and a physiotherapist after discharge. The aim of our study was to evaluate the effect of the PRADO-BPCO program on the 28-days readmission rate of COPD patients after hospitalization for AECOPD.Patients and methodsThis was a retrospective cohort study including all patients admitted for AECOPD in our center between November 2015 and January 2017. The readmission or death rate at 28 days after hospitalization for AECOPD was compared between patients included in the PRADO-BPCO program and patients with standard care after discharge. Inclusion in the program was decided by the physician in charge of the patient.ResultsA total of 62 patients were included in the PRADO-BPCO group and 202 in the control group. At baseline, patients in the PRADO group had a more severe COPD disease and more severe exacerbations than the control group and mean inpatient stay was shorter in the PRADO group: 8.6±4.3 vs 10.4±7.4 days (P=0.034). Readmission or death rate at 28 days was similar between groups: 10 (16.1%) in the PRADO group vs 30 (14.9%) in the control group (P=0.81). Ninety-days readmission or death rate and overall survival were similar in the two groups.ConclusionIn our center, despite more severe COPD and a shorter hospitalization time, the PRADO-BPCO program failed to prove a benefit on the 28 days readmission or death rate when compared with standard care.

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Self-Management: Personalized Action Plans for COPD Exacerbations

Effing

Lenferink

2020

Respiratory Medicine

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Prognostic factors after hospitalization for COPD exacerbation

Cited by 9 publications

References 30 publications

COMET: a multicomponent home-based disease-management programmeversusroutine care in severe COPD

COMET: a multicomponent home-based disease-management programmeversusroutine care in severe COPD

<p>Efficacy of a home discharge care bundle after acute exacerbation of COPD</p>

Self-Management: Personalized Action Plans for COPD Exacerbations

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