30-day Readmission After an Acute Exacerbation of Chronic Obstructive Pulmonary Disease is Associated with Cardiovascular Comorbidity.

Abstract

Readmission after hospitalization for a chronic disease is a major concern of interest for health care quality. Our aim was to investigate the predictors and rates of early readmission after an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in a tertiary care hospital. Over a 3-year period, patients hospitalized in our pulmonary disease clinic with a diagnosis of chronic obstructive pulmonary disease (COPD) and who had an index hospitalization for AECOPD were included. Readmission was defined as rehospitalization within 30 days of AECOPD discharge. Demographics, comorbidities, exacerbations, prior intensive care unit (ICU) stay, and long-term oxygen therapy (LTOT), blood eosinophil count, and antibiotic and/or steroid treatment at the index AECOPD admission were recorded. Fifty-two (17.3%) readmissions occurred in 300 patients. Readmissions were due to AECOPD in 46.2%, pneumonia in 19.2%, and cardiovascular disease in 15.4% patients. Twenty-one (40%) of the readmitted patients were frequent exacerbators. After adjusting for individual and clinical predictors, the odds ratio for readmission was 2.11 (95% CI, 1.07-4.15, P = .03) for those with congestive heart failure, 3.30 (95% CI, 1.05-9.75, P = .04) for those with arrhythmia, and 1.99 (95% CI, 1.04-3.81, P = .04) for LTOT users prior to AECOPD. A significant majority of patients readmitted after an AECOPD mainly suffered from recurrent AECOPD. Associated congestive heart failure, arrhythmia, and prior LTOT were risk factors identified for early AECOPD readmissions in our study. Better recognition of readmission risk factors might help to reduce readmission rates of AECOPD.