Elderly patients with COPD require more health care than elderly heart failure patients do in a hospital-based home care setting
Persson HL, Lyth J, Wiréhn AB, et al.
Intl J COPD 2019;14:1569—81
Elderly patients with advanced chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) are at increased risk of disease-related events and often have exacerbations requiring hospital admission.
In this study, Persson and colleagues investigated whether telemonitoring supported by hospital-based home care (HBHC) would help detect exacerbations of COPD or CHF earlier and reduce rates of hospitalisation. They also assessed the heterogeneity of patients with advanced COPD and CHF in terms of exacerbation frequency and the need for HBHC.
The study cohort included patients aged ≥65 years with ≥2 hospitalisations in the previous year. Participants were instructed to keep a daily health diary using digital pen technology, documenting respiratory symptoms, medications, shortness of breath and weight changes. Incident exacerbations were also recorded and categorised by an experienced physician as either a COPD or CHF exacerbations and treated correspondingly. All HBHC contacts, whether home visits or telephone consultations, were recorded.
94 patients with advanced COPD (n=36) or CHF (n=58) were recruited, of which 53 subjects completed the one year study period (19 COPD and 34 CHF subjects). The primary reason for study non-completion was death, although there was no significant difference in deaths between the COPD and CHF groups. Subjects with COPD had significantly more exacerbations than the subjects with CHF (COPD 3.2±2.7 (0–10); CHF 0.8±0.9 (0–5), p<0.001). Similarly, patients with COPD had significantly more hospitalisations and home care due to the urgent need to treat COPD exacerbations (COPD 94.4±84.4 (3–334); CHF 67.4±38.0 (5–187), p<0.05), compared to CHF. Compared to the 1-year prior inclusion, the intervention of telemonitoring and HBHC significantly reduced rates of hospitalisation.
Subjects with COPD exhibit exacerbations more frequently than patients with CHF, mainly due to disease characteristics. Telehealth supported by HBHC could help reduce the risk that these exacerbations will result in hospitalisation.