Abstract

Objectives: We aimed to analyze the prevalence and impact of COPD in older patients hospitalized in internal medicine or geriatric wards, and to investigate adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, associated clinical factors, and outcomes. Design: Data were obtained from REgistro POliterapie SIMI (REPOSI), a prospective multicenter observational registry that enrolls inpatients aged ≥65 years. Setting and Participants: Older hospitalized patients enrolled from 2008 to 2016 with a diagnosis of COPD. Measures: We evaluated adherence to the 2018 GOLD guidelines at admission and discharge, by examining the prescription of inhaled bronchodilators and corticosteroids in COPD patients. We also evaluated the occurrence of outcomes and its association with COPD and guideline adherence. Results: At hospital admission, COPD was diagnosed in 1302 (21.5%) of 6046 registered patients. COPD patients were older, with more impaired clinical and functional status and multiple comorbidities. Overall, 34.3% of COPD patients at admission and 35.6% at discharge were adherent to the GOLD guidelines. Polypharmacy (≥5 drugs) at admission [odds ratio (OR): 3.28, 95% confidence interval (CI): 2.24-4.81], a history of acute COPD exacerbation (OR: 2.65, 95% CI: 1.44-4.88) at admission, smoking habit (OR: 1.45, 95% CI: 1.08-1.94), and polypharmacy at discharge (OR: 6.76, 95% CI: 4.15-11.0) were associated with adherence to guidelines. COPD was independently associated with the risk of cardiovascular and respiratory death and rehospitalization occurrence compared to patients without COPD during follow-up. Adherence to guidelines was inversely associated with the occurrence of death from all causes (OR: 0.12, 95% CI: 0.02-0.90). Conclusions/Implications: COPD was common in older patients acutely hospitalized, showing an impaired functional and clinical status. Prescriptions for older COPD patients were often not adherent to GOLD guidelines. Poor adherence to guidelines was associated with a worse clinical status. There is a need to improve adherence to guidelines in treating COPD patients, with the ultimate goal of reducing clinical events.

Original languageEnglish
Pages (from-to)1313-1317.e9
JournalJournal of the American Medical Directors Association
Volume20
Issue number10
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Bronchodilator Agents
Chronic Obstructive Pulmonary Disease
Patient Care
Adrenal Cortex Hormones
Guidelines
Guideline Adherence
Odds Ratio
Confidence Intervals
Polypharmacy
Prescriptions
Patient Admission
Internal Medicine

Keywords

  • COPD
  • guidelines adherence
  • major clinical events
  • older patients

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

Cite this

Hospital Care of Older Patients With COPD : Adherence to International Guidelines for Use of Inhaled Bronchodilators and Corticosteroids. / REPOSI investigators; Proietti, Marco; Agosti, Pasquale; Lonati, Chiara; Corrao, Salvatore; Perticone, Francesco; Mannucci, Pier Mannuccio; Nobili, Alessandro; Harari, Sergio.

In: Journal of the American Medical Directors Association, Vol. 20, No. 10, 01.01.2019, p. 1313-1317.e9.

Research output: Contribution to journalArticle

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title = "Hospital Care of Older Patients With COPD: Adherence to International Guidelines for Use of Inhaled Bronchodilators and Corticosteroids",
abstract = "Objectives: We aimed to analyze the prevalence and impact of COPD in older patients hospitalized in internal medicine or geriatric wards, and to investigate adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, associated clinical factors, and outcomes. Design: Data were obtained from REgistro POliterapie SIMI (REPOSI), a prospective multicenter observational registry that enrolls inpatients aged ≥65 years. Setting and Participants: Older hospitalized patients enrolled from 2008 to 2016 with a diagnosis of COPD. Measures: We evaluated adherence to the 2018 GOLD guidelines at admission and discharge, by examining the prescription of inhaled bronchodilators and corticosteroids in COPD patients. We also evaluated the occurrence of outcomes and its association with COPD and guideline adherence. Results: At hospital admission, COPD was diagnosed in 1302 (21.5{\%}) of 6046 registered patients. COPD patients were older, with more impaired clinical and functional status and multiple comorbidities. Overall, 34.3{\%} of COPD patients at admission and 35.6{\%} at discharge were adherent to the GOLD guidelines. Polypharmacy (≥5 drugs) at admission [odds ratio (OR): 3.28, 95{\%} confidence interval (CI): 2.24-4.81], a history of acute COPD exacerbation (OR: 2.65, 95{\%} CI: 1.44-4.88) at admission, smoking habit (OR: 1.45, 95{\%} CI: 1.08-1.94), and polypharmacy at discharge (OR: 6.76, 95{\%} CI: 4.15-11.0) were associated with adherence to guidelines. COPD was independently associated with the risk of cardiovascular and respiratory death and rehospitalization occurrence compared to patients without COPD during follow-up. Adherence to guidelines was inversely associated with the occurrence of death from all causes (OR: 0.12, 95{\%} CI: 0.02-0.90). Conclusions/Implications: COPD was common in older patients acutely hospitalized, showing an impaired functional and clinical status. Prescriptions for older COPD patients were often not adherent to GOLD guidelines. Poor adherence to guidelines was associated with a worse clinical status. There is a need to improve adherence to guidelines in treating COPD patients, with the ultimate goal of reducing clinical events.",
keywords = "COPD, guidelines adherence, major clinical events, older patients",
author = "{REPOSI investigators} and Marco Proietti and Pasquale Agosti and Chiara Lonati and Salvatore Corrao and Francesco Perticone and Mannucci, {Pier Mannuccio} and Alessandro Nobili and Sergio Harari and Mauro Tettamanti and Luca Pasina and Carlotta Franchi and Alessandra Marengoni and Francesco Salerno and Matteo Cesari and Giuseppe Licata and Francesco Violi and Corazza, {Gino Roberto} and Laura Cortesi and Ilaria Ardoino and Mauro Bernardi and Mario Barbagallo and Cappellini, {Maria Domenica} and Giovanna Fabio and Rossi, {Paolo Dionigi} and Sarah Damanti and Emanuela Miceli and Lenti, {Marco Vincenzo} and Giovanni Murialdo and Maria Carbone and Rizzo, {Maria Rosaria} and Christian Bracco and Silvia Fargion and Giulia Periti and Flora Peyvandi and Valter Monzani and Valeria Savojardo and Christian Folli and Franco Dallegri and Bianchi, {Giovanni Battista} and Antonio Mirijello and Chiara Mussi and Martino, {Giuseppe Pio} and Michele Arcopinto and Marra, {Alberto Maria} and Alberto Ballestrero and Franco Berti and Andrea Artoni and Massimo Porta and Alberto Tedeschi and Mara Cattaneo",
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TY - JOUR

T1 - Hospital Care of Older Patients With COPD

T2 - Adherence to International Guidelines for Use of Inhaled Bronchodilators and Corticosteroids

AU - REPOSI investigators

AU - Proietti, Marco

AU - Agosti, Pasquale

AU - Lonati, Chiara

AU - Corrao, Salvatore

AU - Perticone, Francesco

AU - Mannucci, Pier Mannuccio

AU - Nobili, Alessandro

AU - Harari, Sergio

AU - Tettamanti, Mauro

AU - Pasina, Luca

AU - Franchi, Carlotta

AU - Marengoni, Alessandra

AU - Salerno, Francesco

AU - Cesari, Matteo

AU - Licata, Giuseppe

AU - Violi, Francesco

AU - Corazza, Gino Roberto

AU - Cortesi, Laura

AU - Ardoino, Ilaria

AU - Bernardi, Mauro

AU - Barbagallo, Mario

AU - Cappellini, Maria Domenica

AU - Fabio, Giovanna

AU - Rossi, Paolo Dionigi

AU - Damanti, Sarah

AU - Miceli, Emanuela

AU - Lenti, Marco Vincenzo

AU - Murialdo, Giovanni

AU - Carbone, Maria

AU - Rizzo, Maria Rosaria

AU - Bracco, Christian

AU - Fargion, Silvia

AU - Periti, Giulia

AU - Peyvandi, Flora

AU - Monzani, Valter

AU - Savojardo, Valeria

AU - Folli, Christian

AU - Dallegri, Franco

AU - Bianchi, Giovanni Battista

AU - Mirijello, Antonio

AU - Mussi, Chiara

AU - Martino, Giuseppe Pio

AU - Arcopinto, Michele

AU - Marra, Alberto Maria

AU - Ballestrero, Alberto

AU - Berti, Franco

AU - Artoni, Andrea

AU - Porta, Massimo

AU - Tedeschi, Alberto

AU - Cattaneo, Mara

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: We aimed to analyze the prevalence and impact of COPD in older patients hospitalized in internal medicine or geriatric wards, and to investigate adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, associated clinical factors, and outcomes. Design: Data were obtained from REgistro POliterapie SIMI (REPOSI), a prospective multicenter observational registry that enrolls inpatients aged ≥65 years. Setting and Participants: Older hospitalized patients enrolled from 2008 to 2016 with a diagnosis of COPD. Measures: We evaluated adherence to the 2018 GOLD guidelines at admission and discharge, by examining the prescription of inhaled bronchodilators and corticosteroids in COPD patients. We also evaluated the occurrence of outcomes and its association with COPD and guideline adherence. Results: At hospital admission, COPD was diagnosed in 1302 (21.5%) of 6046 registered patients. COPD patients were older, with more impaired clinical and functional status and multiple comorbidities. Overall, 34.3% of COPD patients at admission and 35.6% at discharge were adherent to the GOLD guidelines. Polypharmacy (≥5 drugs) at admission [odds ratio (OR): 3.28, 95% confidence interval (CI): 2.24-4.81], a history of acute COPD exacerbation (OR: 2.65, 95% CI: 1.44-4.88) at admission, smoking habit (OR: 1.45, 95% CI: 1.08-1.94), and polypharmacy at discharge (OR: 6.76, 95% CI: 4.15-11.0) were associated with adherence to guidelines. COPD was independently associated with the risk of cardiovascular and respiratory death and rehospitalization occurrence compared to patients without COPD during follow-up. Adherence to guidelines was inversely associated with the occurrence of death from all causes (OR: 0.12, 95% CI: 0.02-0.90). Conclusions/Implications: COPD was common in older patients acutely hospitalized, showing an impaired functional and clinical status. Prescriptions for older COPD patients were often not adherent to GOLD guidelines. Poor adherence to guidelines was associated with a worse clinical status. There is a need to improve adherence to guidelines in treating COPD patients, with the ultimate goal of reducing clinical events.

AB - Objectives: We aimed to analyze the prevalence and impact of COPD in older patients hospitalized in internal medicine or geriatric wards, and to investigate adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, associated clinical factors, and outcomes. Design: Data were obtained from REgistro POliterapie SIMI (REPOSI), a prospective multicenter observational registry that enrolls inpatients aged ≥65 years. Setting and Participants: Older hospitalized patients enrolled from 2008 to 2016 with a diagnosis of COPD. Measures: We evaluated adherence to the 2018 GOLD guidelines at admission and discharge, by examining the prescription of inhaled bronchodilators and corticosteroids in COPD patients. We also evaluated the occurrence of outcomes and its association with COPD and guideline adherence. Results: At hospital admission, COPD was diagnosed in 1302 (21.5%) of 6046 registered patients. COPD patients were older, with more impaired clinical and functional status and multiple comorbidities. Overall, 34.3% of COPD patients at admission and 35.6% at discharge were adherent to the GOLD guidelines. Polypharmacy (≥5 drugs) at admission [odds ratio (OR): 3.28, 95% confidence interval (CI): 2.24-4.81], a history of acute COPD exacerbation (OR: 2.65, 95% CI: 1.44-4.88) at admission, smoking habit (OR: 1.45, 95% CI: 1.08-1.94), and polypharmacy at discharge (OR: 6.76, 95% CI: 4.15-11.0) were associated with adherence to guidelines. COPD was independently associated with the risk of cardiovascular and respiratory death and rehospitalization occurrence compared to patients without COPD during follow-up. Adherence to guidelines was inversely associated with the occurrence of death from all causes (OR: 0.12, 95% CI: 0.02-0.90). Conclusions/Implications: COPD was common in older patients acutely hospitalized, showing an impaired functional and clinical status. Prescriptions for older COPD patients were often not adherent to GOLD guidelines. Poor adherence to guidelines was associated with a worse clinical status. There is a need to improve adherence to guidelines in treating COPD patients, with the ultimate goal of reducing clinical events.

KW - COPD

KW - guidelines adherence

KW - major clinical events

KW - older patients

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