Abstract Background Chronic lower respiratory diseases cause about 43.4 deaths per 100,000 population and is the fifth leading cause of death in the US, arising mainly from chronic obstructive pulmonary disease (COPD), with additional significant patient and healthcare system burden. Management by pulmonologists is associated with improved outcomes. This retrospective analysis assessed the relationship between the timing of COPD care transition from PCP to pulmonologist and its association with subsequent risk of exacerbations, cardiovascular (CV) events, and death. Methods This retrospective cohort study utilized the Optum Market Clarity database (electronic health records (EHR) linked with claims) to identify patients with COPD diagnosis (ICD-10) from January 2014 to March 2024. Patients were 40-85 years old and transitioned from a PCP to pulmonologist (index = first observed pulmonologist visit) for COPD care. Study assessed the transition between PCP-pulmonologists over 3 years and exacerbations, CV events and death in the 12 months following the index. Patients were stratified based on the time to transition from PCP to pulmonologist visit between 0-12-month (C1), 13-24-month (C2), and 25-36-month (C3) intervals. Rates of moderate-or-severe COPD exacerbation, mortality, or cardiovascular events were compared between the 3 cohorts after index pulmonologist visit. In addition, Cox proportional hazards regression assessing the incremental 30-day risk of subsequent moderate/severe COPD related exacerbations, CV events and death were assessed adjusting for difference in baseline characteristics, including COPD severity (utilization, treatment and exacerbation histories). Results Compared to patients who were transferred to pulmonologist care within 12 months (C1), longer transfer times (C2 and C3) were associated significantly higher rates (events/year) of subsequent moderate-or-severe exacerbations (0.62, 0.81, 1.01), percent with a CV event (50.8%, 55.0%, 58.3%) and death (10.0%, 11.0%, 11.8%) respectively. After adjusting for differences in baseline characteristics, every 30-day delay in transitioning to a pulmonologist was associated with a 0.9% (6-month delay: 5.7%) incremental risk of subsequent moderate-or-severe COPD exacerbation, and a 0.6% (6-month delay: 3.5%) incremental mortality risk in the year following the initial pulmonologist visit. Conclusions Delay in transition of COPD care to a pulmonologist from a PCP was significantly associated with worse clinical outcomes including cardiovascular events. Every 30-day delay in transition of COPD care to a pulmonologist increases the risk of future exacerbations and mortality. Findings suggest that prompt transfer of COPD care to the pulmonologist could improve overall outcomes. This abstract is funded by: Research sponsored by Sanofi and Regeneron Pharmaceuticals, Inc.
Putcha et al. (Fri,) studied this question.