Pulmonary rehabilitation after hospitalization for chronic obstructive pulmonary disease improves mortality

Reference

Lindenauer PK, Stefan MS, Pekow PS, et al. Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among Medicare beneficiaries. JAMA 2020;323(18):1813-1823.

Synopsis

Patients hospitalized for COPD exacerbation have a high rate of health care utilization and an increased risk of mortality up to 1 year following discharge. Although current guidelines recommend pulmonary rehabilitation for patients within 4 weeks of hospitalization for COPD, few patients are enrolled. Using claims data from Medicare fee-for-service patients, these investigators identified 197,376 patients older than 65 years who were hospitalized for COPD. Of this cohort, only 2721 (1.5%) initiated pulmonary rehabilitation within 90 days of discharge, while the remaining either began pulmonary rehabilitation after 90 days or not at all. Patients who initiated within 90 days were younger, more likely to be men or non-Hispanic whites, live closer to a rehabilitation facility, and have fewer comorbidities. Propensity score matching was used to match 2710 patients from the 2 groups. In this matched cohort, initiating pulmonary rehabilitation within 90 days was associated with fewer deaths at 1 year (7.3% vs 14.1%; hazard ratio [HR] 0.50; 95% CI 0.42 - 0.59; number needed to treat = 15). Further, every 3 additional sessions of rehabilitation within the first 90 days were linked to a decreased risk of mortality (HR 0.91; 0.85 - 0.98).