Abstract
Background: We investigated whether the survival advantage of completing Pulmonary Rehabilitation (PR) in the National COPD PR Audit report (Royal College of Physicians) was related to the effects of PR or to confounding due to differences in case-mix severity.
Methods: PR services across England and Wales provided data for consenting patients assessed for PR between Jan - April 2015. Mortality data were extracted from the Office for National Statistics from Jan 2015 to Jan 2017. Time to event analysis, from the end of PR (estimated for non-completers) to Jan 2017, was performed using Cox proportional hazards regression adjusted for baseline gender, age, FEV1, BMI, MRC dyspnoea grade, smoking status, co-morbidities, walking distance, home oxygen use, and hospitalisation in the last year. Multiple imputation was performed for missing data.
Results: 7092 patients with COPD were included and 58% completed PR. There were small but statistically significant differences between completers (slightly younger age P<0.001, lower MRC dyspnoea grade P<0.001, fewer co-morbidities P<0.001, higher walking distance P<0.001, fewer users of home oxygen P=0.03, fewer current smokers P<0.001 and fewer reporting a hospital admission within the last year), compared to non-completers.
The unadjusted mortality rate was higher for non-completers (12.3%) vs. completers (8.3%), mean (95% CI) HR 1.54 [1.33 to 1.78], P<0.001. Cumulative mortality remained higher for non-completers vs completers in the adjusted model HR 1.42 [1.20 to 1.67], P<0.001.
Conclusion: In this large, real-life dataset, we report a survival advantage of completing PR compared to non-completion even after adjustment for baseline case-mix severity.
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, OA3577.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019