Risk of pharmacological treatment of anxiety and depression after admission for acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND: Anxiety and depression are very common in patients with COPD and may lead to lower quality of life and higher risk of exacerbations and mortality. This study aimed to examine the incidence of anxiety and depression within one year after admission with acute exacerbation in COPD (AECOPD). The secondary aim was to examine the characteristics of the patients who develop anxiety and depression. METHODS: This retrospective cohort study used the Danish National Patient Registry. Patients aged 40-90 years admitted for COPD between 01.01.99 and 31.12.18 were included. Patients with mental disorders within 10 years before admission were excluded. Age, sex, educational level, inhaled medication, and comorbidities were evaluated. Anxiety or depression were defined by redemption of anxiolytics or antidepressants within one year after admission. RESULTS: We included 97,929 patients. Anxiolytics and antidepressants were redeemed by 4 and 5 % of patients respectively. Higher age, male sex, treatment with short acting ß2-agonists and short acting muscarinic antagonists, cancer and heart failure were positively associated to risk of anxiety or depression, while diabetes and treatment with triple inhalation therapy showed an inverse association. CONCLUSION: Respectively four and five per cent of patients redeemed anxiolytics and antidepressants within the first year after their first severe AECOPD. Several patient characteristics were significantly associated to risk of anxiety or depression. The results from this study support that there is a risk of anxiety and depression after AECOPD in addition to the known risk of preexisting anxiety and depression.

Disability Retirement After First Admission with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Danish Nationwide Registry Cohort Study Using a Retrospective Follow-Up Design.

Introduction: Many chronic obstructive pulmonary disease (COPD) patients below retirement age are outside the workforce. The existing knowledge about association between acute exacerbation of COPD (AECOPD) and disability retirement is limited. Aim: The aim of this study is to explore disability retirement in COPD patients 3 years following first-ever AECOPD. Methods: This retrospective registry-based follow-up cohort study design is based on nationwide Danish registry data. Patients admitted to the hospital for the first time between 1999 and 2017 with AECOPD and age between 35 and 59 years, active in the workforce, were included in the study. Socio-demographics, comorbidities and inhaled medication use were explored. COPD patients' hazard ratio of disability retirement during 3-year follow-up was calculated. Cox regression was used to examine the effects of covariates on disability retirement. Results: A total of 4032 patients were included in the study. During follow-up, 17.2% (692/4032) experienced disability retirement from the workforce. Factors associated with disability retirement were expressed as hazard ratio (95% confidence intervals): Higher age (ref. age 46-50: Age 51-55, 1.42, (1.12-1.81); age 56-59, 1.37 (1.08-1.74)); living alone (1.34 (1.14-1.56)); number of comorbidities for 1, 2, and 3 comorbidities (1.36 (1.14-1.62), 1.57 (1.19-2.07), 1.77 (1.20-2.60)); emphysema (2.01 (1.44-2.79)); depression (1.60 (1.12-2.28)); cardiac comorbidity (1.38 (1.07-1.78)); triple inhalation therapy (2.76 (2.20-3.47)); ICS + LAMA or ICS + LABA treatment (1.82 (1.48-2.23)); and ICS treatment (1.49 (1.17-1.90)). Higher educational level was associated with a significantly reduced risk of disability retirement, medium, short higher and long higher educational level, relative to low education level (0.78 (0.67-0.91), 0.63 (0.48-0.83) and 0.27 (0.12-0.60)). Conclusion: Patients vulnerable to disability retirement are patients with markers of severe COPD, comorbidities, and social vulnerability.

Out-of-hospital cardiac arrest: Does rurality decrease chances of survival?

BACKGROUND: Geographical setting is seldomly taken into account when investigating out-of-hospital cardiac arrest (OHCA). It is a common notion that living in rural areas means a lower chance of fast and effective helpwhen suffering a time-critical event. This retrospective cohort study investigates this hypothesis and compares across healthcare-divided administrative regions. METHODS: We included only witnessed OHCAs to minimize the risk that outcome was predetermined by time to caller arrival and/or recognition. Arrests were divided into public and residential. Residential arrests were categorized according to population density of the area in which they occurred. We investigated incidence, EMS response time and 30-day survival according to area type and subsidiarily by healthcare-divided administrative region. RESULTS: The majority (71%) of 8,579 OHCAs were residential, and 53.2% of all arrests occurred in the most densely populated cell group amongst residential arrests. This group had a median EMS response time of six minutes, whereas the most sparsely populated group had a median of 10 minutes. Public arrests also had a median response time of six minutes. 30-day survival was highest in public arrests (38.5%, [95% CI 36.9;40.1]), and varied only slightly with no statistical significance between OHCAs in densely and sparsely populated areas from 14.8% (95% CI 14.4;15.2) and 13.4% (95% CI 12.2;14.7). CONCLUSION: Our study demonstrates that while EMS response times in Denmark are longer in the rural areas, there is no statistically significant decrease in survival compared to the most densely populated areas.

Employment Status, Readmission and Mortality After Acute Exacerbation of COPD.

Introduction: The understanding of whether and to what extent employment status affects readmission and mortality is limited in patients with COPD. Aim: To explore how employment status affects readmission and mortality after first admission to the hospital with acute exacerbation of COPD (AECOPD). Methods: This study used Danish national registry-based data. All patients admitted for the first time to the hospital between 1999 and 2014 with a diagnosis of AECOPD, age 35-59, without a previous asthma diagnosis were included in the study. Employment status effect on 30-, 90-, and 365-day readmission and mortality was examined using logistic regression, adjusting for relevant confounders. Results: A total of 11,850 COPD patients were included in the study of which 3563 (30%) were working, 1368 (12%) unemployed, 840 (7%) on sick leave, and 6079 (51%) receiving early retirement. Patients receiving early retirement had, compared to patients working, an adjusted increased likelihood of readmission at 30, 90, and 365 days (odds ratio (OR) 1.26 (CI95% (1.06-1.49)), 1.33 (CI95% (1.16-1.53)), and 1.48 (CI95% (1.33-1.66)), respectively). An increased likelihood was also seen in unemployed at 365 days follow-up (OR 1.44 (CI95% (1.22-1.68))). Early retirement was associated with an increased mortality at 30, 90, and 365 days (OR 1.39 (CI95% (1.07-1.80)) 1.37 (CI95% (1.09-1.79)) and 1.48 (CI95% (1.25-1.75)), respectively). An increased likelihood was also seen in patients receiving sick leave (OR 1.57 (CI95% (1.21-2.04))). Conclusion: Patients with COPD who are not working at the time of first admission have a higher likelihood of readmission and mortality.