Comorbidities in patients with chronic obstructive pulmonary disease (COPD) are not just associated with higher rates of readmission and mortality, but also with fewer beneficial treatments delivered for COPD exacerbations, according to a study published in Annals of the American Thoracic Society.
Researchers sought to challenge the validity of the common assumption that patients with comorbid conditions are at a higher risk for 30-day readmissions and mortality because they are sicker than patients without multiple comorbidities. The investigators theorized that patients with multiple comorbidities may have poorer outcomes because they do not fully benefit from appropriate therapies, or receive fewer therapies due to the diagnostic uncertainty faced by clinicians treating patients with multimorbidity.
Between 2005 and 2011, data were gathered on 2391 patients hospitalized for COPD exacerbations at 6 different Veterans Affairs hospitals. Comorbidities in the year before these hospitalizations were collected, as were the receipts of respiratory antibiotics or systemic corticosteroids during hospitalizations and the rates of 30-day readmissions and death after hospital discharge.
Adjusted analyses showed that every Charlson index point increase was associated with reduced odds of being treated with antibiotics and steroids (adjusted odds ratio [aOR] 0.90; 95% CI, 0.85-0.95) and increased odds of 30-day readmission or mortality (aOR 1.24; 95% CI, 1.18-1.30). Patients with COPD with comorbid kidney disease (aOR 0.74; 95% CI, 0.55-0.99), coronary artery disease (aOR 0.73; 95% CI, 0.60-0.89), and congestive heart failure (aOR 0.64; 95% CI, 0.52-0.79) were much less likely to be treated with antibiotics and corticosteroids than patients with COPD without these comorbidities. The investigators could not identify a comorbidity associated with greater odds of receiving therapies beneficial to COPD exacerbations.
Patients hospitalized for COPD exacerbations frequently have comorbidities, and a greater burden of comorbid conditions is associated with greater chances of readmission and mortality, which may be explained by a reduction in quality of COPD-related care. “Our findings could also provide insight into future quality improvement strategies to better understand this disparity among the patients with COPD, as well as encourage reassessment of the adjustments performed in the [Center for Medicare and Medicaid Services] COPD penalty for comorbidities.”
Spece LJ, Epler EM, Donovan LM, et al. Role of comorbidities in treatment and outcomes after chronic obstructive pulmonary disease exacerbations [published online August 4, 2018]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201804-255OC