Starting pulmonary rehabilitation — including exercise training and physical and psychological education — within 3 months of hospital discharge significantly reduced the risk of 1-year mortality in Medicare beneficiaries hospitalized for chronic obstructive pulmonary disease (COPD), according to study results published in JAMA.
Researchers retrospectively identified claims data from fee-for-service Medicare beneficiaries who were hospitalized for COPD (mean age, 76.9 years) at 4446 acute care hospitals in 2014. In the full cohort, Medicare beneficiaries were classified as having initiated pulmonary rehabilitation within 90 days of discharge (n=2721) or between 91 and 365 days after discharge (n=194,655). The primary outcome of the analysis was all-cause mortality at 1 year.
Overall, approximately 19.4% (n=38,302) of patients died within a 1-year period after hospital discharge. The proportions of patients who died within this timeframe included 7.3% (n=198) of patients who started pulmonary rehabilitation within 90 days of discharge and 19.6% (n=38,104) of patients who started pulmonary rehabilitation after 90 days or not at all.
Patients who started pulmonary rehabilitation within 3 months after discharge had a significantly lower risk of mortality over 1 year (absolute risk difference [ARD], -6.7%; 95% CI, -7.9% to -5.6%; hazard ratio [HR], 0.63; 95% CI, 0.57-0.69; P <.001). Additionally, the initiation of pulmonary rehabilitation correlated with significantly lower mortality rates for start dates of within 30 days of discharge (ARD, -4.6%; 95% CI, -5.9% to -3.2%; HR, 0.74; 95% CI, 0.67-0.82; P <.001) and 61 to 90 days after discharge (ARD, -11.1%; 95% CI, -13.2% to -8.4%; HR, 0.40; 95% CI, 0.30-0.54; P <.001). Every 3 additional pulmonary rehabilitation sessions during the first 90 days after discharge was associated with a significantly reduced risk of mortality (HR, 0.91; 95% CI, 0.85-0.98; P =.01).
Study limitations included its retrospective nature and the lack of a randomized treatment design, as well as the younger mean age in the group of patients who initiated pulmonary rehabilitation within 90 days after discharge (74.5 vs 77.0 years), which the investigators suggested could have partially contributed to the benefits observed in this group.
The researchers wrote that “the results of this study reinforce the importance of developing more effective strategies for increasing participation in rehabilitation.”
Lindenauer PK, Stefan MS, Pekow PS, et al. Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among Medicare beneficiaries. JAMA. 2020;323(18):1813‐1823.