Latest in Pulmonary News

Thirty-Day Hospital Readmission Metric Linked to Increased Mortality for HF and Pneumonia

Physicians are at increased pressure to reduce readmissions for certain chronic diseases. A recent study found that implementation of the 30-day readmission rules has been associated with increased 30-day post-discharge mortality for those hospitalized for heart failure and pneumonia.

Post-discharge deaths have increased by 0.25% for patients hospitalized with heart failure and by 0.40% for patients with pneumonia since the implementation of the 30-day readmission rules.
There are approximately 8 million hospitalizations during the study period. Such small increases may account for a large number of deaths.

The findings, published online in JAMA, come from a retrospective cohort study that compared mortality rates among 8.3 million Medicare beneficiaries hospitalized for these common conditions before and after implementation of the Hospital Readmissions Reduction Program (HRRP). This early data should lead physicians to exercise caution in discharging patients prematurely.

Source: Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, Acute Myocardial Infarction, and Pneumonia. JAMA. 2018;320(24):2542-2552. doi:10.1001/jama.2018.19232

Add Corticosteroids to Your Arsenal for the treatment of Inpatient Community-Acquired Pneumonia.

Corticosteroids were both beneficial and cost-effective for hospitalized adults with severe CAP. Hospitalized people with non-severe CAP may also benefit from corticosteroid therapy, but with no survival advantage

In 2015, results of two randomized trials showed that systemic corticosteroids were beneficial for some hospitalized patients with community-acquired pneumonia (CAP; NEJM JW Gen Med Mar 15 2015 and JAMA 2015; 313:677; NEJM JW Gen Med Mar 1 2015 and Lancet 2015; 385:1511). Now, two new meta-analyses — one by the Cochrane Library, and one by the Infectious Diseases Society of America (IDSA) — address whether CAP patients should receive systemic corticosteroids routinely.

These meta-analyses suggest that low-dose (≈40 mg), short-course (3–7 days) systemic corticosteroids should be strongly considered for hospitalized adults with severe CAP. These results do not apply to outpatients with CAP or to inpatients with hospital-acquired pneumonia or ventilator-associated pneumonia. Several ongoing randomized trials probably will clarify steroid use further for pneumonia indications.

Source:
The Cost-effectiveness of Corticosteroids for the treatment of Community-Acquired Pneumonia
Chest. 2018 Nov 15. pii: S0012-3692(18)32727-2. doi: 10.1016/j.chest.2018.11.001.
https://www.ncbi.nlm.nih.gov/pubmed/30448195?dopt=Abstract

Home oxygen therapy for COPD: Does it matter whether the patient is hypoxemic? Evidence vs Reality

Home oxygen therapy for COPD: Does it matter whether the patient is hypoxemic? Evidence vs Reality?

Long-term oxygen therapy (LTOT) is given to improve survival time in people with COPD and severe chronic hypoxemia at rest. The efficacy of oxygen therapy for breathlessness and health-related quality of life (HRQOL) in people with COPD and mild or no hypoxemia who do not meet the criteria for LTOT has not been established. Scientific evidence for its benefits of LTOT dates back to the 1980s when two randomized controlled trials showed prolonged survival in COPD-patients undergoing LTOT for at least 15 hours/day. In contrast, the potential benefits of LTOT in non-COPD-patients has not been well researched and the recommendations for its application are primarily extrapolated from trials on COPD-patients.

Recent Cochrane analysis found that oxygen can relieve breathlessness when given during exercise to mildly hypoxaemic and non-hypoxaemic people with chronic obstructive pulmonary disease who would not otherwise qualify for home oxygen therapy. Findings show that COPD patients without severe hypoxemia undergoing oxygen therapy during exercise training over time do not achieve better exercise capacity or health-related quality of life compared with placebo.

However, LTOT has a beneficial effect on quality of life, dyspnea, and exercise capacity in patients with COPD and exertional hypoxemia.

Source:
Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006429.pub3/full

J Bras Pneumol. 2018 Sep-Oct;44(5):390-397. doi: 10.1590/S1806-37562017000000019.
Impact of adherence to long-term oxygen therapy on patients with COPD and exertional hypoxemia followed for one year.
https://www.ncbi.nlm.nih.gov/pubmed/30517340

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