Pedro J Marcos1, Cristina Represas Represas2, Cristina Ramos2, Blanca Cimadevila Álvarez3, Alberto Fernández Villar2, Angélica Fraga Liste3, Susana Fernández Nocelo3, Javier Quiles Del Río3, Carlos Zamarrón Sanz4, Rafael Golpe5, José Abal Arca6, Uxío Calvo Álvarez7, Sonia Pértega8, Julio García Comesaña9. 1. Servicio de Neumología, Dirección Asistencial, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Area Sanitaria da Coruña e Cee, Sergas, Universidade da Coruña (UDC), As Xubias, 15006 A Coruña, Spain. Electronic address: Pedro.jorge.marcos.rodriguez@sergas.es. 2. Servicio de Neumología, NeumoVigoI+i Research Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Hospital Álvaro Cunqueiro de Vigo, Sergas, Spain. 3. Servicio Galego de Saude (SERGAS), Santiago de Compostela, Galicia, Spain. 4. Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS), Sergas, Spain. 5. Servicio de Neumología, Hospital Universitario Lucus Augusti de Lugo, Sergas, Spain. 6. Servicio de Neumología, Complejo Hospitalario Universitario de Ourense (CHUOU), Sergas, Spain. 7. Sección de Neumología, Hospital Arquitecto Marcide de Ferrol, Sergas, Spain. 8. Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias, 15006 A Coruña, Spain. 9. Xerencia, Estructura Organizativa Integrada (EOXI) de Vigo, Sergas, Spain.
Abstract
INTRODUCTION: Currently there is lack of data regarding the impact of a home telehealth program on readmissions and mortality rate after a COPD exacerbation-related hospitalization. OBJECTIVE: To demonstrate if a tele-monitoring system after a COPD exacerbation admission could have a favorable effect in 1-year readmissions and mortality in a real-world setting. METHODS: This is an observational study where we compared an intervention group of COPD patients treated after hospitalization that conveyed a telehealth program with a followance period of 1 year with a control group of patients evaluated during one year before the intervention began. A propensity-score analyses was developed to control for confounders. The main clinical outcome was 1-year all-cause mortality or COPD-related readmission. RESULTS: The analysis comprised 351 telemonitoring patients and 495 patients in the control group. The intervention resulted in less mortality or readmission after 12 months (35.2% vs. 45.2%; hazard ratio [HR] 0.71 [95% CI=0.56-0.91]; p=0.007). This benefit was maintained after the propensity score analysis (HR=0.66 [95% CI=0.51-0.84]). This benefit, which was seen from the first month of the study and during its whole duration, is maintained when mortality (HR=0.54; 95% CI=[0.36-0.82]) or readmission (subdistribution hazard ratio [SHR] 0.66; 95% CI=[0.50-0.86]) are analyzed separately. CONCLUSION: Telemonitoring after a severe COPD exacerbation is associated with less mortality or readmissions at 12 months in a real world clinical setting.
INTRODUCTION: Currently there is lack of data regarding the impact of a home telehealth program on readmissions and mortality rate after a COPD exacerbation-related hospitalization. OBJECTIVE: To demonstrate if a tele-monitoring system after a COPD exacerbation admission could have a favorable effect in 1-year readmissions and mortality in a real-world setting. METHODS: This is an observational study where we compared an intervention group of COPD patients treated after hospitalization that conveyed a telehealth program with a followance period of 1 year with a control group of patients evaluated during one year before the intervention began. A propensity-score analyses was developed to control for confounders. The main clinical outcome was 1-year all-cause mortality or COPD-related readmission. RESULTS: The analysis comprised 351 telemonitoring patients and 495 patients in the control group. The intervention resulted in less mortality or readmission after 12 months (35.2% vs. 45.2%; hazard ratio [HR] 0.71 [95% CI=0.56-0.91]; p=0.007). This benefit was maintained after the propensity score analysis (HR=0.66 [95% CI=0.51-0.84]). This benefit, which was seen from the first month of the study and during its whole duration, is maintained when mortality (HR=0.54; 95% CI=[0.36-0.82]) or readmission (subdistribution hazard ratio [SHR] 0.66; 95% CI=[0.50-0.86]) are analyzed separately. CONCLUSION: Telemonitoring after a severe COPD exacerbation is associated with less mortality or readmissions at 12 months in a real world clinical setting.