Disease burden and health-related outcomes of patients discharged from hospital following a COPD exacerbation in the United States.

Background: Evidence on trajectory of readmission rates post-hospitalization for COPD exacerbations and combined cardiopulmonary risk in the U.S. is sparse.

Objective: To describe incidence of outcomes and treatment patterns post-hospitalization for a COPD exacerbation.

Methods: This was an observational study of patients discharged from hospital post-COPD exacerbation in the U.S. (01.01.18-09.30.21) using data from the Optum® Clinformatics® Data Mart database. Index date was the discharge date of first recorded hospitalization for a COPD exacerbation during the study period. Primary outcomes were frequency and time to post-discharge events (hospital readmissions, all-cause mortality, and severe cardiopulmonary events). Post-discharge COPD medication prescription patterns, frequency and time-to-triple-therapy escalation were assessed secondarily.

Results: Overall, 38,483 patients were included. One-year post-discharge, 34.6 % of patients (incidence rate [IR] 42.2/100 patient years [PY], 95% CI: 41.5, 42.9) experienced ≥1 severe cardiopulmonary event, 16.7 % (IR 20.4/100 PY; 95 % CI: 19.8, 20.9) had a COPD readmission and 18.2 % (IR 22.2/100 PY; 95 % CI: 21.7, 22.7) died. Upon discharge, 27.4 % and 17.5 % of patients were prescribed reliver only/no COPD treatment and triple-therapy, respectively. Of 17,991 not prescribed triple maintenance COPD therapy 6-months pre-hospitalization or within 14-days post-discharge, 29.5 % eventually escalated to triple-therapy (mean (SD) time-to-escalation: 337.6 (340.2) days).

Conclusion: Treatment patterns post-hospitalization for a COPD exacerbation in the U.S. don't align with recognized standards (e.g. GOLD recommendations). Patients discharged from hospital post-COPD exacerbation have a high risk of severe cardiopulmonary events, hospital readmission and death. Opportunities exist to improve post-hospitalization COPD management practices, including timely intervention with triple-therapy as appropriate.