Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the Elderly

Cardiopulmonary Rehabilitation in Elderly Patients with Heart Failure: A Prospective Cohort Study

Objective

To determine the impact of cardiopulmonary rehabilitation administered through WeChat on exercising resilience and life quality in aged people with heart failure (HF).

Methods

We conducted prospective cohort study that included 80 heart failure patients who were admitted to the Second Affiliated Hospital of Wenzhou Medical University from June 2018 to September 2020, 80 patients with heart failure. Patients were grouped according to their use of WeChat for rehabilitation. WeChat cohort provides remote supervision of rehabilitation and nursing guidance through WeChat. Specifically, the findings below were predetermined and compared across treatment groups utilizing analysis of variance corrected for baseline levels of the end measure and location: changes in the length of cardiopulmonary exercise tests, peak VO2, the proportion of predicted maximum VO2, and variation in the distance covered during the 6-minute walk distance (6MWD) assessment. Comparison of negative emotions between two groups, a Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS), and Survey Short Form-36 (SF36) at baseline and at month 2.

Results

In contrast with the control cohort, the WeChat cohort did not show any significant differences in general data (P > 0.05). After the rehabilitation, the WeChat group has a notably higher level in 6MWD than in the control group. Prior to the rehabilitation, there were no statistical gaps between the two cohorts in terms of SAS and SDS scores (P > 0.05). Even though the two cohorts saw a decline in SAS and SDS scores following nursing, the observation cohort indicated a much relatively low level in contrast with the control cohort (P < 0.05). The comparison of the SF-36 scores between the two cohorts revealed no significant differences (P > 0.05). Following nursing, the scores of the two cohorts declined significantly, with the control cohort scoring far lower than the other (P < 0.05).

Conclusions

In summary, cardiopulmonary rehabilitation via WeChat is very beneficial for HF patients who are at a stable phase of the disease. It may substantially improve patients' exercise stamina, reduce adverse emotions, boost patients' quality of life, and have significant clinical relevance.

Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation

BACKGROUND

Optimization of the clinical care process by integration of evidence-based knowledge is one of the active components in care pathways. When studying the impact of a care pathway by using a cluster-randomized design, standardization of the care pathway intervention is crucial. This methodology paper describes the development of the clinical content of an evidence-based care pathway for in-hospital management of chronic obstructive pulmonary disease (COPD) exacerbation in the context of a cluster-randomized controlled trial (cRCT) on care pathway effectiveness.

METHODS

The clinical content of a care pathway for COPD exacerbation was developed based on recognized process design and guideline development methods. Subsequently, based on the COPD case study, a generalized eight-step method was designed to support the development of the clinical content of an evidence-based care pathway.

RESULTS

A set of 38 evidence-based key interventions and a set of 24 process and 15 outcome indicators were developed in eight different steps. Nine Belgian multidisciplinary teams piloted both the set of key interventions and indicators. The key intervention set was judged by the teams as being valid and clinically applicable. In addition, the pilot study showed that the indicators were feasible for the involved clinicians and patients.

CONCLUSIONS

The set of 38 key interventions and the set of process and outcome indicators were found to be appropriate for the development and standardization of the clinical content of the COPD care pathway in the context of a cRCT on pathway effectiveness. The developed eight-step method may facilitate multidisciplinary teams caring for other patient populations in designing the clinical content of their future care pathways.

Can a health forecasting service offer COPD patients a novel way to manage their condition?

Objectives:

The UK Meteorological Office (Met Office) has developed a health forecasting service for chronic obstructive pulmonary disease (COPD) patients, combining a rule-based model predicting risk based on environmental conditions with an anticipatory care intervention providing information on self-management and warnings via an interactive telephone call. Our aim was to explore the acceptability and utility of such a service to patients with COPD and its perceived impact on their behaviour and disease management.

Methods:

A cross-sectional questionnaire survey of service users drawn from 189 general practices in England, Scotland and Wales at the end of the winter of 2007/8.

Results:

Completed questionnaires were received from 3288 COPD patients, representing a response rate of 40%. Eighty-five percent of those returning a questionnaire reported at least one exacerbation during the study period and 8% had been admitted to hospital on one occasion or more. The majority of respondents deemed the information pack (comprising a booklet and thermometers) useful while the automated calls were generally said to be convenient, easy to understand and reassuring. Those less satisfied with the service felt they were already sufficiently aware of the prevailing weather conditions or felt more detailed information was needed. Most benefit was reported by those patients who were willing to be pro-active in the management of their condition, with the service encouraging 36% of respondents to seek a repeat prescription, 28% to reread their information pack and 12% to consult their GP for worsening of symptoms.

Conclusions:

Patients found the automated interactive calling, combined with a health risk forecast, both viable and useful, welcoming the information and tools it offered. In many cases, it added to patients’ understanding of their illness and promoted better self-management. Future research should focus on the potential impact of the service in terms of health outcomes and cost-effectiveness.

Hospital and emergency department utilization associated with treatment for chronic obstructive pulmonary disease in a managed-care Medicare population

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition with high morbidity and mortality among older and disabled adults. Few studies have examined the comparative effectiveness of maintenance therapies for chronic obstructive pulmonary disease (COPD) in this vulnerable population.

OBJECTIVES

The study aims to compare healthcare resource utilization associated with hospitalization or emergency department (ED) visits between FDA-approved inhaled corticosteroid/long-acting beta-agonist combinations [fluticasone propionate 250 microg/salmeterol 50 microg combination (FSC)] and anticholinergic treatments (ATC) in managed-care Medicare beneficiaries with COPD.

RESEARCH DESIGN AND METHODS

Data from the Integrated Health Care Information Systems (IHCIS) National Managed Care Benchmark Database was used in this retrospective, observational cohort study. The cohort consisted of managed-care Medicare beneficiaries with a diagnosis of COPD [International Classification of Disease, 9th revision, Clinical Modification (ICD-9-CM) codes 491.xx, 492.xx, or 496.xx] without evidence of comorbid asthma (ICD-9-CM 493.xx) who received treatment with FSC or ATC between 2003 and 2005. Cox proportional hazards regression models were conducted to examine the risk of all-cause and COPD-related hospitalizations and emergency department (ED) visits.

RESULTS

COPD patients treated with FSC had a 18% lower risk of a COPD-related hospitalization (HR = 0.82; 95% CI = 0.75, 0.89) and an ED visit (HR = 0.82; 95% CI = 0.76, 0.89) compared to patients treated with ATC. Findings were similar for all-cause utilization (hospitalization HR = 0.83; 95% CI = 0.78, 0.88; ED visit HR = 0.84; 95% CI = 0.80, 0.88).

CONCLUSIONS

FSC is associated with a lower risk of COPD-related exacerbation events relative to ATC in managed-care Medicare beneficiaries with COPD. Findings from this study are only generalizable to managed-care Medicare beneficiaries residing in the community.