Abstract
Objectives: To determine how often hospitalized older adults principally diagnosed with pneumonia, chronic obstructive pulmonary disease (COPD), or heart failure (HF) are concurrently treated for two or more of these acute cardiopulmonary conditions. Design: Retrospective cohort study. Setting: 368 U.S. hospitals in the Premier research database. Participants: Individuals aged 65 and older principally hospitalized with pneumonia, COPD, or HF in 2009 or 2010. Measurements: Proportion of diagnosed episodes of pneumonia, COPD, or HF concurrently treated for two or more of these acute cardiopulmonary conditions during the first 2 hospital days. Results: Of 91,709 diagnosed pneumonia hospitalizations, 32% received treatment for two or more acute cardiopulmonary conditions (18% for HF, 18% for COPD, 4% for both). Of 41,052 diagnosed COPD hospitalizations, 19% received treatment for two or more acute cardiopulmonary conditions (all of which involved additional HF treatment). Of 118,061 diagnosed HF hospitalizations, 38% received treatment for two or more acute cardiopulmonary conditions (34% for pneumonia, 9% for COPD, 5% for both). Conclusion: Hospitalized older adults diagnosed with pneumonia, COPD, or HF are frequently treated for two or more acute cardiopulmonary conditions, suggesting that clinical syndromes often fall between traditional diagnostic categories. Research is needed to evaluate the risks and benefits of real-world treatment for the many older adults whose presentations elicit diagnostic uncertainty or concern about coexisting acute conditions.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1574-1582 |
| Number of pages | 9 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 64 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 1 2016 |
Funding
These data were presented in part at the Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Scientific Sessions of the American Heart Association, May 15–17, 2013, Baltimore, Maryland. Conflict of Interest: Dr. Dharmarajan is a member of a scientific advisory board for Clover Health. Dr. Dharmarajan, Ms. Strait, Dr. Lindenauer, and Dr. Krumholz work under contract with the Centers for Medicare and Medicaid Services to develop and maintain performance measures. Dr. Krumholz is the chair of a cardiac scientific advisory board for UnitedHealth. Dr. Krumholz is the recipient of research grants from Medtronic and Johnson & Johnson, through Yale University, to develop methods of clinical trial data sharing. This project was supported by Grant DF10–301 from the Patrick and Catherine Weldon Donaghue Medical Research Foundation in West Hartford, Connecticut; Grant UL1 RR024139–06S1 from the National Center for Advancing Translational Sciences in Bethesda, Maryland; and a John A. Hartford Foundation Center of Excellence Career Development Award to Dr. Dharmarajan through Yale University. Dr. Dharmarajan is additionally supported by Grant K23AG048331–02 from the National Institute on Aging and the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program. Dr. Lagu is supported by Grant K01HL114745–03 from the National Heart, Lung, and Blood Institute. Dr. Krumholz is supported by Grant 1U01HL105270–05 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not represent the official views of the Patrick and Catherine Weldon Donaghue Medical Research Foundation, National Center for Advancing Translational Sciences, John A. Hartford Foundation, National Institute on Aging, American Federation for Aging Research, or National Heart, Lung, and Blood Institute. Author Contributions: Dharmarajan, Krumholz: study concept and design, obtained funding. Krumholz: acquisition of data; administrative, technical, or material support; study supervision. Dharmarajan, Strait, Tinetti, Lagu, Lindenauer, Lynn, Krukas, Ernst, Li, Krumholz: analysis and interpretation of data. Dharmarajan: drafting of the manuscript. Dharmarajan, Strait, Tinetti, Lagu, Lindenauer, Lynn, Krukas, Ernst, Li, Krumholz: critical revision of the manuscript for important intellectual content. Strait: statistical analysis. Sponsor's Role: The sponsors had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; in the preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
Keywords
- cardiovascular disease
- comorbidity
- hospital medicine
- pharmacoepidemiology
- pulmonary diseases
ASJC Scopus subject areas
- Geriatrics and Gerontology
