Are patients with Chronic Obstructive Pulmonary Disease treated according to guidelines with non-invasive ventilation when 30- day mortality rates rise? Results of an internal audit.

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) in exacerbation is globally a frequent cause of admission. In Denmark, annual national epidemiological data on COPD patients have been reported since 2008, and there has been registered a reduction in admissions due to COPD in exacerbation of approximately 25% compared to 2014. There has also been revealed regional differences in use of non-invasive ventilation (NIV) and mortality, and especially, the 30-day mortality rate was significantly higher at Odense University Hospital compared to the other regions in 2022, where the number of admissions was even lower due to the effect of the COVID- 19 pandemic. We therefore decided to repeat an internal audit of all admissions with COPD exacerbation with focus on in-house initiation of NIV as an add-on treatment to standard treatment and mortality.

Methods: Patient data was collected from medical records from the COPD cohort, and the cohort was defined by discharge between 1 st of January to 31 st of December 2023, admission at Odense University Hospital, and confirmed COPD exacerbation.

Results: The COPD cohort comprised in all 396 patients. NIV criteria were fulfilled in 112 patients and initiation of NIV in 92.9%. The 30-day mortality rate was in this cohort 16.2%. Patients who died within 30 days, were significantly older than patients still alive, although there was no difference in comorbidities. The patients, who received NIV and died, had significantly fewer comorbidites compared to patients who died and did not receive NIV.

Conclusions: Acute treatment was given according to guidelines, and the need of NIV was found in 28% of the patients in the cohort. The patients that died were significantly older compared to survivors. The increased mortality can therefore be a consequence of admissions with an ageing population, and, hence, more fragile COPD patients. The COPD population in Denmark is getting older, although there are still some patients with severe COPD dying at younger age.