PURPOSE: Approximately 10-14% of COPD patients are rehospitalized within 14 days of discharge from an acute exacerbation (AECOPD). The purpose of this study was to identify factors associated with rehospitalization within 14 days (relapse) of discharge from an AECOPD.
METHODS: We abstracted data from hospitalized AECOPD patients admitted to two inter-city North American hospitals over an 12-month period and created 3 groups: 1) 1 hospitalization only; 2) >1 hospitalization but no relapses; and 3) >1 hospitalization and 1+ relapse. Differences between the 3 groups were tested using ANOVA and Cochran-Armitage trend test for continuous and categorical data, respectively.
RESULTS: Data on 82 patients were abstracted. The 14 day rehospitalization rate was ~15%. There were no differences between the groups in gender, age, FEV1 % predicted or FEV1/FVC, or smoking history. The average length of stay for Group 1 and Group 2 patients was ~10 days, compared to ~15 days for the index and relapse hospitalizations for Group 3. Group 3 patients also had significantly more hospitalizations during the study period. Group 3 patients were more likely to be of Aboriginal ethnicity (33%, p< 0.05) , and have a significant substance abuse history (50%, p< 0.05). Despite the trend of being more likely to have abnormalities on their ECG, no Group 3 patients received a cardiologist consult during their initial or relapse hospitalization, compared to 5% of Group 2 patients and 11% of Group 1 patients.
CONCLUSION: Patients with AECOPD with early relapse (within 14 days) have longer lengths of stay in the hospital and are frequent exacerbators. Predisposing factors for relapse in our population were substance abuse, Aboriginal ethnicity and poor cardiovascular work-up and care.
CLINICAL IMPLICATIONS: Early relapse of AECOPD may be related to important comorbidities such as substance abuse and underlying cardiovascular disease. Future work on the relationship between cardiac abnormalities and treatment relapse for AECOPD is needed. Appropriate identification and care of co-morbidities while in hospital may reduce the likelihood of relapse and rehospitalization for AECOPD.
DISCLOSURE: Pat Camp, No Financial Disclosure Information; No Product/Research Disclosure Information