Source: International Congress 2015 – Best abstracts in chronic care
Disease area: Airway diseases

Abstract

Background: ICMPs for COPD patients have shown promising reduction in hospital utilization due to acute exacerbations of COPD (AECOPD), but comprehensive analysis of secondary outcomes such as mortality are incomplete.Aims: To study mortality hazards and causes among the participants in COPD-Home, an ICMP for patients with COPD GOLD stage III or IV.Methods: A single centre, prospective, open, controlled study with an intervention consisting of an education program, self-management plan, home visits by specialist nurses and a call centre for support for patients and the municipality home care nurses who assist the frailest patients in their homes.Results: 171 patients mean age 73.4 years, mean FEV1% 33.3 were randomly allocated to the integrated care group (ICG), n=91 or the usual care group (UCG), n=81. During the two year follow-up period hospital utilization was significantly reduced in the ICG compared to the UCG. The number of deaths was 35 (38.5%) in the ICG compared to 21 (25.9%) in the UCG, hazard ratio 1.33 [95% CI 0.77 to 2.33]. The most frequent primary cause of death was AECOPD and/or pneumonia, 22 (62.8%) in the ICG versus 10 (47.6%) in the UCG. In univariate survival analysis the shortest survival time was found in patients receiving home-care nursing with high age (³80 years), low BMI and high PaCO₂. In multivariate survival analysis mortality was significantly related to a lower BMI (p=0.008) and home-care nursing (p=0.017).Conclusion: There was a trend towards a shorter survival time among the patients in the ICG compared to the UCG. In multivariate survival analysis mortality was significantly related to a lower BMI and home-care nursing.


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Elena Valerevna Titova (Trondheim, Norway), Elena Titova, Sigurd Steinshamn, Anne Henriksen. An integrated care management program (ICMP) for patients with severe COPD; mortality, hazards and causes. Eur Respir J 2015; 46: Suppl. 59, 3072

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