Mortality after an emergency department visit for exacerbation of chronic obstructive pulmonary disease.

Overview

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 1,128 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.