Risk factors for hospital readmission for COPD after implementation of the GOLD guidelines

Int J Tuberc Lung Dis. 2016 Mar;20(3):396-401. doi: 10.5588/ijtld.15.0256.

Abstract

Background: Few updated studies have investigated risk factors for readmission for chronic obstructive pulmonary disease (COPD) since the implementation of the latest treatment guidelines.

Objective: To evaluate a series of potential risk factors for readmission in patients with COPD and in a subgroup with very frequent readmissions after implementation of the Global Initiative for Chronic Obstructive Lung Disease guidelines.

Design: Two hundred and fifty patients admitted for acute exacerbation of COPD (AECOPD) were recruited over 1 year. The readmission frequency in the ensuing year following hospital discharge was recorded and analysed against potential risk factors collected during the index admission.

Results: In the ensuing year, 183 (73.2%) patients were readmitted at least once for AECOPD. Previous non-invasive ventilation for AECOPD (HR 1.56, 95%CI 1.08-2.26), COPD Assessment Test score (HR 1.03, 95%CI 1.00-1.05), 6-minute walk distance (HR 0.98 per 10 m increase, 95%CI 0.97-0.99) and number of admissions for AECOPD in the previous year (HR 1.11, 95%CI 1.06-1.16) were independently associated with time to first readmission. Subgroup analysis showed that anxiety (OR 3.97, 95%CI 1.49-10.57) was strongly associated with very frequent readmissions (⩾4 in 1 year).

Conclusions: AECOPD is associated with high rates of readmission. Anxiety is a potential modifiable factor associated with very frequent readmissions.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Patient Discharge
  • Patient Readmission / statistics & numerical data*
  • Practice Guidelines as Topic
  • Proportional Hazards Models
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / diagnosis*
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Risk Factors