A recent study identified 3 themes as important patient-reported outcomes that can help predict hospitalizations among patients with COPD.
The study assessed 493 COPD patients at a Mayo Clinic outpatient pulmonary clinic (mean age, 70 years; 54% male; forced expiratory volume in 1 second predicted 42.8 ± 16.7; modified Medical Research Council dyspnea scale score, 2 ± 1.13). Investigators used a rigorous psychometric approach with multiple sensitivity analyses to help forecast risk of hospitalization. They defined specific cut points that allowed for simple interpretation and definition of risk. Factor- and cluster-analysis routines were followed to demonstrate that the internal structure of the original measures was demonstrated in their application setting.
The results support the hypothesis that the feeling of fear or panic due to shortness of breath was the most predictive question in their algorithm (a 57% risk of hospitalization) and further emphasize the importance of symptoms of depression and anxiety (fear) in the health of COPD patients. Anxiety is associated with increased risk of exacerbations, poorer health-related quality of life (QOL), worse physical activity, relapse within 1 month of receiving emergency treatment, and hospital readmission. Depression is associated with increased mortality, impaired health-related QOL, and excessive healthcare utilization rates and costs.
The algorithm presented incorporates patient-reported information that has not been used routinely or systematically in clinical practice, the researchers noted.
“This algorithm to identify patients at higher risk of hospitalization will have false positives and negatives; however, it is not intended as a diagnostic laboratory test, but a supplementary source of information for the clinician,” they concluded.
