Early Pulmonary rehabilitation in COPD Patients may prevent risk of readmission in hospital
Chronic obstructive pulmonary disease (COPD) is one of the most common chronic conditions worldwide. Among Medicare beneficiaries 65 years or older admitted to the hospital with a COPD exacerbation, approximately 20% are readmitted within 30 days, and 64% are readmitted within 1 year of discharge. Recent study findings added further value to the current guideline recommendations surrounding the role of pulmonary rehabilitation (PR) after an exacerbation.
The researchers reported that early pulmonary rehabilitation following hospitalization with COPD was associated with a reduced risk of readmission in the following year. The study findings were published in the American Journal of Respiratory and Critical Care Medicine on July 20, 2021.
Based on the previous study findings, the American Thoracic Society, the European Respiratory Society, and the American College of Chest Physicians recommended initiation of PR within 3 weeks of an exacerbation for the treatment of patients with COPD. However, little is known about the effectiveness of PR in preventing readmissions in routine clinical practice settings, and results from prior studies are conflicting. Therefore, Dr Mihaela S. Stefan and her team conducted a study to evaluate the association between initiation of PR within 90 days of discharge and rehospitalization(s).
It was a retrospective cohort of Medicare beneficiaries (66 years of age or older) hospitalized for COPD in 2014 who survived at least 30 days after discharge. The researchers used propensity score matching and estimated the risk of recurrent all-cause rehospitalizations at 1 year using a multistate model to account for the competing risk of death.
Key findings of the study were:
- Upon analysis, the researchers noted that among 197,376 total patients hospitalized in 4,446 hospitals, 2,721 patients (1.5%) initiated PR within 90 days of discharge.
- They observed that 56.4% of patients who initiated PR and 64.6% who did not were rehospitalized one or more times within 1 year of discharge.
- Upon propensity-score–matched analysis, they found that PR initiation was associated with a lower risk of readmission in the year after PR initiation (hazard ratio, 0.83).
- They noted that the mean cumulative number of rehospitalizations at 1 year was 0.95 for those who initiated PR within 90 days and 1.15 for those who did not.
The authors concluded, "After hospitalization for COPD, Medicare beneficiaries who initiated PR within 90 days of discharge experienced fewer rehospitalizations over 1 year. These results support findings from randomized controlled clinical trials and highlight the need to identify effective strategies to increase PR participation."
For further information:
DOI: 10.1164/rccm.202012-4389OC
