Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Rationale: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and health care costs, and hospitals in the United States are now penalized by the Centers for Medicare and Medicaid Services for excessive readmissions. Identifying patients at risk of readmission is important, but modifiable risk factors have not been clearly established, and the potential contributing role of psychological disease has not been examined adequately. We hypothesized that depression and anxiety would increase the risk of both short-and long-term readmissions for acute exacerbation of COPD.Objectives: To characterize the associations between depression and anxiety and COPD readmission risk. Methods:We examined the medical records for all patients with a primary diagnosis of acute exacerbation of COPD by International Classification of Diseases, Ninth Revision codes admitted to the University of Alabama at Birmingham Hospital between November 2010 and October 2012. Those who did not meet the standardized study criteria for acute exacerbation of COPD and those with other respiratory illnesses as the primary diagnosis were excluded. Comorbidities were recorded on the basis of physician documentation of the diagnosis and/or the use of medications in the electronic medical record. Multivariable regression analyses identified factors associated with readmission for acute exacerbation of COPD at 1 year and within 30 and 90 days.Measurements and Main Results: Four hundred twenty-two patients were included, with 132 readmitted in 1 year. Mean age was 64.8 6 11.7 years, and mean percent predicted FEV 1 was 48.1 6 18.7%. On univariate analysis, readmitted patients had lower percent predicted FEV 1 (44.9 6 17.3% vs. 50.2 6 19.4%; P = 0.05) and a higher frequency of depression (47.7% vs. 23.4%; P , 0.001). On multivariable analysis, 1-year readmission was independently associated with depression (adjusted odds ratio [OR], 2.67; 95% confidence interval [CI], 1.59-4.47) and in-hospital tobacco cessation counseling (adjusted OR, 0.34; 95% CI, 0.18-0.66). Depression also predicted readmission at 30 days (adjusted OR, 3.83; 95% CI, 1.84-7.96) and 90 days (adjusted OR, 2.47; 95% CI, 1.34-4.55).Conclusions: Depression is an independent risk factor for both short-and long-term readmissions for acute exacerbation of COPD and may represent a modifiable risk factor. In-hospital tobacco cessation counseling was also associated with reduced 1-year readmission.

Predictors of Hospital Readmissions for Ulcerative Colitis in the United States

“…35 Depression also increased the readmission risk in chronic obstructive pulmonary disease. 36 Our results highlight the importance of addressing depression in UC, particularly during and after hospitalization. 30–32 …”

Risk factors of chronic obstructive pulmonary disease exacerbations

“…Moreover the prevalence of depression in COPD patients increases with the disease severity therefore 60% of long‐term oxygen therapy recipients are suffering from this comorbidity. They are correlated with an increased risk of re‐admission for AECOPD of COPD and have negative effects on therapeutic adherence . Chronic psychological stress may weaken the immune system and may increase the susceptibility to respiratory infections and AECOPD …”

“…They also showed that anxiety increased the risk of 30‐days readmission (OR = 2.65, P = 0.003). Anxiety and depression frequently coexist, and the latter appears to be a stronger predictor for readmissions …”

Expanding The INSPIRED COPD Outreach Program^TM to the emergency department: a feasibility assessment

“…Breathlessness as a symptom is a common cause for ambulance transfers to an emergency department (ED)2 and COPD is second only to chest pain as a medical reason to visit the ED at QEII Health Sciences Centre in Halifax, Nova Scotia (QEII ED data base). While dyspnea in advanced COPD is almost universal this is often compounded by psychosocial issues such as anxiety, depression and panic disorder that are common in this population and powerful determinants of ED visits 3. Patients are often caught in a repetitive cycle of repeated ED visits that follow a pattern of acute management of biomedical issues and hospital discharge without assesment of long term and/or broader care needs that consequently remain unmet 4,5…”