Denitza P. Blagev, MD1,2 Dave S. Collingridge, PhD1,3 Susan Rea, PhD3,4 Valerie G. Press, MD, MPH5 Matthew M. Churpek, MD, MPH, PhD5 Kyle Carey, MPH5 Richard A. Mularski, MD, MSHS, MCR6,7 Siyang Zeng, MS8,9 Mehrdad Arjomandi, MD8,9
Author Affiliations
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, Utah
- Division of Respiratory, Critical Care, and Sleep Medicine, Department of Medicine, University of Utah, Salt Lake City
- Office of Research, Intermountain Healthcare, Salt Lake City, Utah
- Homer Warner Center for Informatics Research, Murray, Utah
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
- Kaiser Permanente Center for Health Research – Northwest, Portland, Oregon
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland
- Division of Pulmonary and Critical Care Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Pulmonary, Critical Care Allergy, Immunology and Sleep Medicine, Department of Medicine, University of California, San Francisco
Abstract
Rationale: Although chronic obstructive pulmonary disease (COPD) exacerbation frequency is stable in research cohorts, whether severe COPD exacerbation frequency can be used to identify patients at high risk for future severe COPD exacerbations and/or mortality is unknown.
Methods: Severe COPD exacerbation frequency stability was determined in 3 distinct clinical cohorts. A total of 17,450 patients with COPD in Intermountain Healthcare were categorized based on the number of severe COPD exacerbations per year. We determined whether exacerbation frequency was stable and whether it predicted mortality. These findings were validated in 83,134 patients from the U.S. Veterans Affairs (VA) nationwide health care system and 3326 patients from the University of Chicago Medicine health system.
Results: In the Intermountain Healthcare cohort, the majority (84%, 14,706 patients) had no exacerbations in 2009 and were likely to remain non-exacerbators with a significantly lower 6-year mortality compared with frequent exacerbators (2 or more exacerbations per year) (25% versus 57%, p<0.001). Similar findings were noted in the VA health system and the University of Chicago Medicine health system. Non-exacerbators were likely to remain non-exacerbators with the lowest overall mortality. In all cohorts, frequent exacerbator was not a stable phenotype until patients had at least 2 consecutive years of frequent exacerbations. COPD exacerbation frequency predicted any cause mortality.
Conclusions: In clinical datasets across different organizations, severe COPD exacerbation frequency was stable after at least 2 consecutive years of frequent exacerbations. Thus, severe COPD exacerbation frequency identifies patients across a health care system at high risk for future COPD-related health care utilization and overall mortality.
Citation
Citation: Blagev DP, Collingridge DS, Rea S, et al. Stability of frequency of severe chronic obstructive pulmonary disease exacerbations and health care utilization in clinical populations. J COPD F. 2018; 5(3): 208-220. doi: http://doi.org/10.15326/jcopdf.5.3.2017.0183