Dataset Information

Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Subsequent Risk of Emergency Department Visits and Hospitalizations for Atrial Fibrillation.

ABSTRACT: Background Although emerging evidence has suggested the relationship of chronic obstructive pulmonary disease with atrial fibrillation (AF), little is known about whether acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of repeated AF-related healthcare utilization. Methods This is a self-controlled case series study using the population-based emergency department (ED) and inpatient databases of 5 US states from 2007 through 2012. Among patients with existing AF, we identified patients with an AECOPD hospitalization and at least 1 ED visit or hospitalization for AF during the observation period. We constructed conditional Poisson regression models to compare the rate of AF-related ED visits or hospitalizations during sequential 90-day periods after the AECOPD hospitalization, with pre-AECOPD days 1 to 90 as the reference. Results We analyzed 944 patients who were hospitalized for AECOPD and had an ED visit or hospitalization for AF during a 450-day period. The median age was 77 years, and 41% were men. Compared with the reference period, the rate of AF-related ED visits or hospitalizations significantly increased in the post-AECOPD days 1 to 90 (7.3 versus 14.1 per 100 person-months; rate ratio, 1.93; 95% CI, 1.63-2.29; P<0.001). Then, the rate decreased to the reference level in the post-AECOPD days 91 to 180 (7.5 per 100 person-months; rate ratio, 1.03; 95% CI, 0.85-1.25; P=0.77) and remained at the reference level during post-AECOPD days 181 to 270 (rate ratio, 0.84; 95% CI, 0.68-1.03; P=0.09) and days 271 to 360 (rate ratio, 0.90; 95% CI, 0.73-1.10; P=0.29). These temporal associations persisted with stratification by age, sex, and season. Conclusions Among patients with existing AF, AECOPD was associated with a higher risk of AF-related ED visit or hospitalization in the first 90-day post-AECOPD period.

SUBMITTER: Hirayama A

PROVIDER: S-EPMC7735661 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Subsequent Risk of Emergency Department Visits and Hospitalizations for Atrial Fibrillation.

Hirayama Atsushi A Goto Tadahiro T Shimada Yuichi J YJ Faridi Mohammad Kamal MK Camargo Carlos A CA Hasegawa Kohei K

Circulation. Arrhythmia and electrophysiology 20180901 9

Background Although emerging evidence has suggested the relationship of chronic obstructive pulmonary disease with atrial fibrillation (AF), little is known about whether acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of repeated AF-related healthcare utilization. Methods This is a self-controlled case series study using the population-based emergency department (ED) and inpatient databases of 5 US states from 2007 through 2012. Among patients with existi ...[more]

PMID: 30354294

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Project description:Vaso-occlusive episodes (VOEs) are a hallmark of sickle cell disease (SCD), and account for >90% of health care encounters for this patient population. The Cooperative Study of Sickle Cell Disease, a large study enrolling >3000 patients, showed that the majority of SCD patients (80%) experienced 0-3 major pain crises/year. Only a small minority (~5%) experienced ≥6 VOEs/year. Our study sought to further understand this difference in VOE frequency between SCD patients. We analyzed 25 patients (13M/12F, mean age of 28.8) with ≥6 ED visits or hospitalizations/year (high utilizers), and compared these with 9 patients (6M/3F, mean age of 37.6) who had ≤2 ED visits or hospitalizations/year (low utilizers). All subjects were given a demographic survey along with questionnaires for depression, anxiety, and Health Locus of Control. Each subject then underwent quantitative sensory testing (QST) with three different modalities: pressure pain sensitivity, heat and cold sensitivity, and Von Frey monofilament testing. Laboratory and clinical data were collected through subjects' medical records. CBC and chemistry analysis showed high utilizers had higher WBC (p<0.01), ANC (p<0.01), total bilirubin (p = 0.02), and lower MCV (p = 0.03). Opioid use (morphine equivalents) over the past 6 months was significantly higher in the high utilizer group (12125.7 mg vs 2423.1 mg, p = 0.005). QST results showed lower pressure pain threshold at the ulna (224.4 KPa vs 338.9 KPa, p = 0.04) in the high utilizer group. High utilizers also had higher anxiety (9.0 vs 4.6, p = 0.04) and depression scores (10.0 vs 6.0, p = 0.051). While the low utilizer group had higher education levels with more associate and bachelor degrees (p = 0.009), there was no difference in income or employment. These data show that many biological and psychosocial factors contribute to high health care utilization in SCD. A multi-disciplinary and multi-faceted approach will be required to address this complex problem.

Dataset Information

Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Subsequent Risk of Emergency Department Visits and Hospitalizations for Atrial Fibrillation.

Publications

Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Subsequent Risk of Emergency Department Visits and Hospitalizations for Atrial Fibrillation.

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