Pulmonary rehab after COPD hospitalization reduces mortality: JAMA
USA: Initiating pulmonary rehabilitation within 3 months of discharge in patients hospitalized for COPD, significantly lowered the risk of mortality at 1 year, according to a recent study published in the journal JAMA. The authors state that these findings are in accordance with the current guideline recommendations for pulmonary rehabilitation after COPD hospitalization.
Peter K. Lindenauer, University of Massachusetts Medical School—Baystate, Springfield, and colleagues determined the association between the initiation of pulmonary rehabilitation within 90 days of hospital discharge and 1-year survival.
This study used claims data from fee-for-service Medicare beneficiaries hospitalized for COPD in 2014, at 4446 acute care hospitals in the US. The final date of follow-up was December 31, 2015. They were initiated with pulmonary rehabilitation within 90 days of hospital discharge.
The primary outcome was all-cause mortality at 1 year.
Key findings of the study include:
- Of 197 376 patients (mean age, 76.9 years; 115 690 [58.6%] women), 2721 (1.5%) initiated pulmonary rehabilitation within 90 days of discharge.
- A total of 38 302 (19.4%) died within 1 year of discharge, including 7.3% of patients who initiated pulmonary rehabilitation within 90 days and 19.6% of patients who initiated pulmonary rehabilitation after 90 days or not at all.
- Initiation within 90 days was significantly associated with a lower risk of death over 1 year (absolute risk difference [ARD], –6.7%]; hazard ratio [HR], 0.63).
- Initiation of pulmonary rehabilitation was significantly associated with lower mortality across the start dates ranging from 30 days or less (ARD, –4.6%; HR, 0.74) to 61 to 90 days after discharge (ARD, –11.1%; HR, 0.40).
- Every 3 additional sessions was significantly associated with a lower risk of death (HR, 0.91).
"Among fee-for-service Medicare beneficiaries hospitalized for COPD, initiation of pulmonary rehabilitation within 3 months of discharge was significantly associated with a lower risk of mortality at 1 year. These findings support current guideline recommendations for pulmonary rehabilitation after hospitalization for COPD, although the potential for residual confounding exists and further research is needed," concluded the authors.
The study, "Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries," is published in the journal JAMA.
