Risk factors and associated outcomes of hospital readmission in COPD: A systematic review

Njoku, Chidiamara; Alqahtani, Jaber S; Wimmer, Barbara C.; Peterson, Gregory M.; Kinsman, Leigh; Hurst, John R.; Bereznicki, Bonnie

doi:10.1016/j.rmed.2020.105988

Cited by 47 publications

(45 citation statements)

References 90 publications

(266 reference statements)

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“…We strongly advocate that the reduction in the rate of hospital admissions for COPD exacerbation during the COVID-19 pandemic and the positive attitudes of people living with airways diseases toward maintaining adoption of physical interventions indicates a need to reassess infection control measures in future COPD guidelines. Including such measures could potentially also reduce the high burden of hospital re-admissions for COPD exacerbations [38,39]. Novel strategies to prevent COPD exacerbations have been identified as a top priority by patients and clinicians in a recent research prioritisation exercise [14].…”

Section: Discussionmentioning

confidence: 99%

Reduction in COPD exacerbations during COVID-19: a systematic review and meta-analysis

Alqahtani

Oyelade²,

Aldhahir

et al. 2021

Preprint

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Background Reports have suggested a reduction in exacerbations of chronic obstructive pulmonary disease (COPD) during the coronavirus (COVID-19) pandemic, particularly hospital admissions for severe exacerbations. However, the magnitude of this reduction varies between studies. Method Electronic databases were searched from January 2020 to May 2021. Two independent reviewers screened titles and abstracts and, when necessary, full text to determine if studies met inclusion criteria. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. A narrative summary of eligible studies was synthesised, and meta-analysis was conducted using a random effect model to pool the rate ratio and 95% confidence intervals (95% CI) for hospital admissions. Exacerbation reduction was compared against the COVID-19 Containment and Health Index. Results A total of 13 of 745 studies met the inclusion criteria and were included in this review, with data from nine countries. Seven studies could be included in the meta-analysis. The pooled rate ratio of hospital admissions for COPD exacerbations during the pandemic period was 0.50 (95% CI 0.42-0.58). Findings on the rate of community-treated exacerbations were inconclusive. Three studies reported a significant decrease in the incidence of respiratory viral infections compared with the pre-pandemic period. There was not a significant relationship between exacerbation reduction and the COVID-19 Containment and Health Index. Conclusion There was a 50% reduction in admissions for COPD exacerbations during the COVID-19 pandemic period, associated with a reduction in respiratory viral infections that trigger exacerbations. We provide pooled evidence supporting the potential effectiveness of COVID-19 preventive interventions in reducing the risk of admissions for COPD exacerbations.

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Section: Discussionmentioning

confidence: 99%

Reduction in COPD exacerbations during COVID-19: a systematic review and meta-analysis

Alqahtani

Oyelade²,

Aldhahir

et al. 2021

Preprint

Self Cite

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“…Although these results were not consistent with previous studies that the resources and place of healthcare provision are ostensible drivers of re-admission, 38 we believe that, re-admission rates will vary depending on the existence of support frameworks in different regions as shown in other systematic reviews. 39 Additionally, there was a systematic review that no single comorbidity was associated with COPD re-admission, 40 but when expanded to all-cause hospital re-admission, three comorbidities (heart failure, renal failure and depression) were related.…”

Section: Discussionmentioning

confidence: 99%

The Association with COPD Readmission Rate and Access to Medical Institutions in Elderly Patients

Kim¹,

Choi²,

Kim³

et al. 2021

COPD

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Purpose Up to 20% of patients with chronic obstructive pulmonary disease (COPD) require re-admission within 30 days of discharge after hospitalization for acute exacerbations of the disease. These re-admissions can increase morbidity and the economic burden of COPD. Reducing re-admissions has become a policy target in many developed countries. We investigated the risk factors for COPD re-admissions among older adults with COPD. Patients and Methods Data obtained from the National Health Insurance Service-Senior Cohort (NHIS-SC) in Korea were analyzed. The subjects included 558,147 patients aged ≥70 who had been admitted for COPD between 2013 and 2015. Re-admission was defined as being re-hospitalized within 30 days after discharge. The key variables selected from the database included income-based insurance contributions, demographical variables, information on inpatient medical services, types of healthcare facilities, and emergency time relevance index (TRI). The TRI is a regional medical-use analysis index that evaluates whether the capacity of the medical services available is appropriate for the medical needs of the target residents. Results In 814 COPD re-admission cases among 4867 total admissions due to COPD in elderly subjects, higher re-admission rates were associated with male sex, admission to district hospitals, medical aid recipients, and a longer hospital stay. When additionally adjusting the TRI to identify the difference in re-admission rates due to medical service accessibility, the same results were found, except for the areas of residence. The TRI was lower in re-admission cases (odds ratio 0.991 [95% CI, 0.984‒0.998], P = 0.013). Conclusion In this study, COPD re-admission rates among older adults were significantly associated with sex, length of hospital stay, and the type of hospital. The capacity of the medical services provided was also related to the COPD re-admission rate. Better access to appropriate emergency services is associated with reduction of COPD re-admission rates.

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“…55 72 Such interventions can be tailored to the local healthcare environment in order to reduce exacerbation, hospital readmissions and mortality. 73 We report here that very few (3/18) studies assessed ankle dorsiflexor muscle using US in patients with COPD. However, of these studies, most reported a reduced muscle quality in the form of increased US echo intensity in patients with COPD compared with healthy subjects.…”

Section: Discussionmentioning

confidence: 87%

“… 55 72 Such interventions can be tailored to the local healthcare environment in order to reduce exacerbation, hospital readmissions and mortality. 73 …”

Section: Discussionmentioning

confidence: 99%

Diagnostic and clinical values of non-cardiac ultrasound in COPD: A systematic review

et al. 2020

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BackgroundClinical and research utility of non-cardiac ultrasound (US) in chronic obstructive pulmonary disease (COPD) has been widely investigated. However, there is no systematic review assessing the clinical values of non-cardiac US techniques in COPD.MethodsWe systematically searched electronic databases from inception to 24 June 2020. Two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines extracted data. A narrative synthesis of the results was conducted considering non-cardiac US techniques that looked for diaphragm, muscles and bones in patients with COPD.ResultsIn total, 2573 abstracts were screened, and 94 full-text papers were reviewed. A total of 54 studies met the inclusion criteria. Thirty-five studies assessed the diaphragm, while 19 studies evaluated different muscles, including limb muscles and pulmonary lesions in COPD using US. Of the 54 included studies, 30% (16/54) evaluated the changes in either limb muscles or diaphragmatic features before and after physical interventions; 67% (36/54) assessed the correlations between sonographic features and COPD severity. Indeed, 14/15 and 9/13 studies reported a significant reduction in diaphragm excursion and thickness in COPD compared with healthy subjects, respectively; this was correlated significantly with the severity and prognosis of COPD. Three studies reported links between diaphragm length and COPD, where lower diaphragm length correlated with poorer prognosis and outcomes. Quadriceps (rectus femoris), ankle dorsiflexor (tibialis anterior) and vastus lateralis were the most common muscles in COPD assessed by US. More than 70% (12/17) of the studies reported a significant reduction in the cross-sectional area (CSA) of the rectus femoris, rectus femoris and vastus lateralis thickness in COPD compared with healthy subjects. Quadriceps CSA and thickness correlated positively with COPD prognosis, in which patients with reduced quadriceps CSA and thickness have higher risk of exacerbation, readmission and death.ConclusionUS measurements of diaphragm excursion and thickness, as well as lower limb muscles strength, size and thickness, may provide a safe, portable and effective alternative to radiation-based techniques in diagnosis and prognosis as well as tracking improvement postintervention in patients with COPD.

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Risk factors and associated outcomes of hospital readmission in COPD: A systematic review

Cited by 47 publications

References 90 publications

Reduction in COPD exacerbations during COVID-19: a systematic review and meta-analysis

Reduction in COPD exacerbations during COVID-19: a systematic review and meta-analysis

The Association with COPD Readmission Rate and Access to Medical Institutions in Elderly Patients

Diagnostic and clinical values of non-cardiac ultrasound in COPD: A systematic review

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