View Abstract

A4965 - One-Year Readmissions for COPD, Home Oxygen and NIV Use: The Current State in the United States
Author Block: K. Chatterjee1, A. Goyal2, A. A. Innabi1, S. Alam1; 1University of Arkansas for Medical Sciences, Little Rock, AR, United States, 2Einstein Medical Center, Little Rock, AR, United States.
Introduction A recent multicentric trial in the U.K. suggested among patients with persistent hypercapnia 2-4 weeks after Chronic Obstructive Pulmonary Disease (COPD) exacerbation, home NIV with O2 was associated with prolonged time to readmission or death within 12 months compared to home O2 alone (1). In the U.S., there are about half a million hospitalizations with COPD exacerbation every year. A significant proportion of these hospitalizations represent readmissions as the prevalence of 30-day readmission in patients hospitalized for COPD is about 18%. We aim to determine the burden of 1-year readmission, prevalence of home O2 and NIV use among patients hospitalized for COPD in the U.S. Methods Using the Nationwide Readmission Database (NRD) 2014, we identified the proportion of patients (age>18) who already had home oxygen therapy or home NIV when they were hospitalized with a primary diagnosis of COPD exacerbation. We excluded patients who might have other indications for NIV like obesity hypoventilation syndrome, obstructive sleep apnea, and neuromuscular lung disease. We then examined patients who were discharged alive after COPD exacerbation in January 2014 and followed them till December to determine the burden of 1-year readmission.
Results There were 341,226 patients who were admitted for COPD exacerbation at least once in 2014. Their mean age was 69.8 years; 56% were males. About 20% of these patients were already on home oxygen, however, less than 1% patients were on home NIV. There were 47,182 index admissions with COPD exacerbation in January 2014. Of these, 26984 (57.2%) were readmitted at least once within one year. Among those who got readmitted, the median number of readmissions was 2; and 38% patients were readmitted > 3 times. 54% readmissions were primarily due to respiratory issues; specifically, 30% due to COPD exacerbation.
Discussion Our analyses indicate an extremely low prevalence of home NIV use among individuals hospitalized for COPD exacerbation in the U.S. If the result of the NIV trial by Murphy et al. are reproducible in the U.S., the potential benefit in terms of reduction in COPD readmissions can be massive, especially given a low number needed to treat in the trial. Eventually, construction of selection criteria and cost-benefit analysis for this intervention may help guide future policy.
References 1. Murphy PB et al. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: JAMA. May 2017.