The Association Between Depressive Symptoms and Acute Exacerbations of COPD

Jennings, Jeffrey; DiGiovine, Bruno; Obeid, Dany; Frank, Catherine

doi:10.1007/s00408-009-9135-9

Cited by 87 publications

(72 citation statements)

References 50 publications

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“…Importantly, although depression has been shown to be an independent risk factor for mortality in patients with COPD and is linked with an increased risk of exacerbations (27,(33)(34)(35), little is known about the association between depression and readmissions for acute exacerbation of COPD. As far as we know, our study is the first to show that depression is associated with an increased risk of both short-and long-term readmissions for acute exacerbation of COPD (36).…”

Section: Original Researchmentioning

confidence: 99%

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2016

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Rationale: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and health care costs, and hospitals in the United States are now penalized by the Centers for Medicare and Medicaid Services for excessive readmissions. Identifying patients at risk of readmission is important, but modifiable risk factors have not been clearly established, and the potential contributing role of psychological disease has not been examined adequately. We hypothesized that depression and anxiety would increase the risk of both short-and long-term readmissions for acute exacerbation of COPD.Objectives: To characterize the associations between depression and anxiety and COPD readmission risk. Methods:We examined the medical records for all patients with a primary diagnosis of acute exacerbation of COPD by International Classification of Diseases, Ninth Revision codes admitted to the University of Alabama at Birmingham Hospital between November 2010 and October 2012. Those who did not meet the standardized study criteria for acute exacerbation of COPD and those with other respiratory illnesses as the primary diagnosis were excluded. Comorbidities were recorded on the basis of physician documentation of the diagnosis and/or the use of medications in the electronic medical record. Multivariable regression analyses identified factors associated with readmission for acute exacerbation of COPD at 1 year and within 30 and 90 days.Measurements and Main Results: Four hundred twenty-two patients were included, with 132 readmitted in 1 year. Mean age was 64.8 6 11.7 years, and mean percent predicted FEV 1 was 48.1 6 18.7%. On univariate analysis, readmitted patients had lower percent predicted FEV 1 (44.9 6 17.3% vs. 50.2 6 19.4%; P = 0.05) and a higher frequency of depression (47.7% vs. 23.4%; P , 0.001). On multivariable analysis, 1-year readmission was independently associated with depression (adjusted odds ratio [OR], 2.67; 95% confidence interval [CI], 1.59-4.47) and in-hospital tobacco cessation counseling (adjusted OR, 0.34; 95% CI, 0.18-0.66). Depression also predicted readmission at 30 days (adjusted OR, 3.83; 95% CI, 1.84-7.96) and 90 days (adjusted OR, 2.47; 95% CI, 1.34-4.55).Conclusions: Depression is an independent risk factor for both short-and long-term readmissions for acute exacerbation of COPD and may represent a modifiable risk factor. In-hospital tobacco cessation counseling was also associated with reduced 1-year readmission.

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Section: Original Researchmentioning

confidence: 99%

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2016

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“…Among patients with COPD, depression remains one of the most common, yet least recognized and undertreated, comorbidities, with a prevalence of 17-44% (21)(22)(23)(24)(25)(26)(27). Depression has been associated with decreased adherence to maintenance medications used in chronic conditions such as diabetes (28,29).…”

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confidence: 99%

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

et al. 2016

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Rationale: Among individuals with chronic obstructive pulmonary disease (COPD), depression is one of the most common yet underrecognized and undertreated comorbidities. Although depression has been associated with reduced adherence to maintenance medications used in other conditions, such as diabetes, little research has assessed the role of depression in COPD medication use and adherence.Objectives: The objective of this study was to assess the impact of depression on COPD maintenance medication adherence among a nationally representative sample of Medicare beneficiaries newly diagnosed with COPD. Methods:We used a 5% random sample of Medicare administrative claims data to identify beneficiaries diagnosed with COPD between 2006 and 2010. We included beneficiaries with 2 years of continuous Medicare Parts A, B, and D coverage and at least two prescription fills for COPD maintenance medications after COPD diagnosis. We searched for prescription fills for inhaled corticosteroids, long-acting b-agonists, and long-acting anticholinergics and calculated adherence starting at the first fill. We modeled adherence to COPD maintenance medications as a function of new episodes of depression, using generalized estimated equations.Measurements and Main Results: Our primary outcome was adherence to COPD maintenance medications, measured as proportion of days covered. The exposure measure was depression. Both COPD and depression were assessed using diagnostic codes in Part A and B data. Covariates included sociodemographics, as well as clinical markers, including comorbidities, COPD severity, and depression severity. Of 31,033 beneficiaries meeting inclusion criteria, 6,227 (20%) were diagnosed with depression after COPD diagnosis. Average monthly adherence to COPD maintenance medications was low, peaking at 57% in the month after first fill and decreasing to 35% within 6 months. In our adjusted regression model, depression was associated with decreased adherence to COPD maintenance medications (odds ratio, 0.93; 95% confidence interval, 0.89-0.98).Conclusions: New episodes of depression decreased adherence to maintenance medications used to manage COPD among older adults. Clinicians who treat older adults with COPD should be aware of the development of depression, especially during the first 6 months after COPD diagnosis, and monitor patients' adherence to prescribed COPD medications to ensure best clinical outcomes.

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“…In addition to increasing all-cause mortality, 5 depression afflicting patients with COPD is associated with worse general and pulmonary health and greater disability. 7,8 Given the high mortality of depressed patients with COPD, identifying predictors of mortality in such patients may inform clinical practice and public health prevention strategies. We sought to identify predictors of all-cause mortality in patients with severe COPD with major depression admitted to a rehabilitation hospital who participated in a treatment adherence intervention trial.…”

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confidence: 99%

Predictors of All-Cause Mortality in Patients With Severe COPD and Major Depression Admitted to a Rehabilitation Hospital

Yohannes

Raue

Kanellopoulos

et al. 2016

Chest

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The Association Between Depressive Symptoms and Acute Exacerbations of COPD

Abstract: COPD patients with depressive symptoms have a significantly higher risk for exacerbations. Early screening for depression in patients with COPD may help identify those patients at higher risk for subsequent exacerbations.

Cited by 87 publications

References 50 publications

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

Predictors of All-Cause Mortality in Patients With Severe COPD and Major Depression Admitted to a Rehabilitation Hospital

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