Mortality after an Emergency Department Visit for Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Objective. To describe the mortality after emergency department (ED) visits for chronic obstructive pulmonary disease (COPD) exacerbation. Design. Retrospective cohort study of ED patients with COPD exacerbation. Setting. Administrative data analysis. Participants. Patients age 55 and over who visited the ED during a 2-year period with primary ICD-9 codes of 491, 492, or 496. Measurements. Demographic characteristics, comorbid conditions, hospital utilization for COPD, and vital status. Results. During the study period, there were 482 index visits with a median follow-up of 1,1 28 days (3.1 years). Demographic characteristics of the cohort were as follows: mean age 72 years, 56% female, 93% White, and 37% currently married. Mortality increased over time: 5% at 30 days, 9% at 60 days, 11% at 90 days, 16% at 180 days, 23% at 1 year, 32% at 2 years, and 39% at 3 years. At the end of follow-up, 220 (46%) patients had died. On multivariate analysis, independent predictors of mortality were increasing age (hazard ratio [HR] 1.3 per 5-year increase, 95% CI 1.2–1.4), having congestive heart failure (HR 1.6, 95% CI 1.2–2.1), having metastatic solid tumor (HR 3.3, 95% CI 2.0–5.5), and hospital utilization for COPD exacerbation during past year (HR 1.9, 95% CI 1.4–2.6). Conclusion. The mortality rate after an ED visit for COPD exacerbation is quite high. Mortality is related to older age, specific comorbid conditions, and history of prior COPD exacerbations.