title: Adherence to treatment guidelines and long-term survival in hospitalized patients with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Adherence to treatment guidelines in chronic obstructive pulmonary disease (COPD) has been shown to be less than optimal over the COPD continuum. This retrospective study aimed to assess the implementation of COPD guidelines and potential association with long-term mortality in patients with COPD.
  
  
  METHODS
  All consecutive patient discharges in the period of February 2002-June 2007 from the University Clinic of Pulmonary and Allergic Diseases Golnik, Slovenia, were screened for a primary discharge diagnosis of COPD.
  
  
  RESULTS
  Data on 1185 patients (mean age 70 ± 9 years, 72% men, 64% GOLD stage III/IV) were analysed. In the discharge letters 62% of patients had three or more drugs prescribed; 3% had no regular prescription. Most patients were discharged with short-acting (91%) and long-acting β2-agonists (LABAs, 65%) and inhaled corticosteroids (61%), and 23% received long-term oxygen therapy. Prescription rates of LABAs, tiotropium and inhaled corticosteroids increased over the disease continuum (P < 0.001). In total, 48% of patients died during a median follow-up of 1149 days. Deceased patients had been less often treated with LABAs, inhaled corticosteroids and tiotropium. In multivariate Cox proportional-hazards analysis, advanced age, current smoking status, lower body mass index, longer hospital stay and cancer were associated with higher mortality (P < 0.05 for all), and inhaled corticosteroids predicted lower mortality (hazard ratio 0.72, 95% confidence interval 0.55-0.94).
  
  
  CONCLUSIONS
  Implementation of guideline-recommended therapy was not optimal, particularly in patients who died during follow-up. The high long-term mortality calls for careful risk assessment and appropriate adherence to treatment guidelines.
authors.affiliation: University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia. irena.sarc@klinika-golnik.si
authors.forename: Irena
authors.initials: I
authors.lastname: Sarc
authors.forename: Tina
authors.initials: T
authors.lastname: Jeric
authors.forename: Kristina
authors.initials: K
authors.lastname: Ziherl
authors.forename: Stanislav
authors.initials: S
authors.lastname: Suskovic
authors.forename: Mitja
authors.initials: M
authors.lastname: Kosnik
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
mesh_terms: D000368:Aged; D004358:Drug Therapy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D017524:Slovenia / Q000453:epidemiology; D013534:Survival