title: Hospital readmissions following initiation of nebulized arformoterol tartrate or nebulized short-acting beta-agonists among inpatients treated for COPD.
abstract: BACKGROUND
  Inpatient admissions for chronic obstructive pulmonary disease (COPD) represent a significant economic burden, accounting for over half of direct medical costs. Reducing 30-day readmissions could save health care resources while improving patient care. Recently, the Patient Protection and Affordable Care Act authorized reduced Medicare payments to hospitals with excess readmissions for acute myocardial infarction, heart failure, and pneumonia. Starting in October 2014, hospitals will also be penalized for excess COPD readmissions. This retrospective database study investigated whether use of arformoterol, a nebulized long-acting beta agonist, during an inpatient admission, had different 30-day all-cause readmission rates compared with treatment using nebulized short-acting beta agonists (SABAs, albuterol, or levalbuterol).
  
  
  METHODS
  A US nationally representative hospital database was used to study adults aged ≥40 years, discharged between January, 2006 and March, 2010, and with a diagnosis of COPD. Patients receiving arformoterol on ≥80% of days following treatment initiation were compared with patients receiving a nebulized SABA during hospitalization. Arformoterol and nebulized SABA patients were matched (1:2) for age, sex, severity of inpatient admission, and primary/secondary COPD diagnosis. Logistic regression compared the odds of readmission while adjusting for age, sex, race, admission type, severity, primary/secondary diagnosis, other respiratory medication use, respiratory therapy use, oxygen use, hospital size, and teaching status.
  
  
  RESULTS
  This retrospective study compared 812 arformoterol patients and 1,651 nebulized SABA patients who were discharged from their initial COPD hospital admission. An intensive care unit stay was more common among arformoterol patients (32.1% versus 18.4%, P<0.001), suggesting more severe symptoms during the initial admission. The observed readmission rate was significantly lower for arformoterol patients than for nebulized SABA patients (8.7% versus 11.9%, P=0.017), as were the adjusted odds of readmission (odds ratio 0.69, 95% confidence interval 0.51-0.92).
  
  
  CONCLUSIONS
  All-cause 30-day readmission rates were significantly lower for arformoterol patients than nebulized SABA patients, both before and after adjusting for patient and hospital characteristics.
authors.affiliation: Sunovion Pharmaceuticals, Inc., Marlborough, MA.
authors.forename: Vamsi
authors.initials: V
authors.lastname: Bollu
authors.affiliation: Premier healthcare alliance, Charlotte, NC.
authors.forename: Frank R
authors.initials: FR
authors.lastname: Ernst
authors.affiliation: Sunovion Pharmaceuticals, Inc., Marlborough, MA.
authors.forename: John
authors.initials: J
authors.lastname: Karafilidis
authors.affiliation: Sunovion Pharmaceuticals, Inc., Marlborough, MA.
authors.forename: Krithika
authors.initials: K
authors.lastname: Rajagopalan
authors.affiliation: Premier healthcare alliance, Charlotte, NC.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Robinson
authors.affiliation: The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Sidney S
authors.initials: SS
authors.lastname: Braman
mesh_terms: D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D057186:Comparative Effectiveness Research; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D000068759:Formoterol Fumarate; D006801:Humans; D064412:Levalbuterol / Q000008:administration & dosage; D016015:Logistic Models; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009330:Nebulizers and Vaporizers; D016017:Odds Ratio; D010359:Patient Readmission; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D004983:Ethanolamines; D064412:Levalbuterol; D000420:Albuterol; D000068759:Formoterol Fumarate
keywords: adrenergic β2 receptor agonists; case-control studies; comparative effectiveness research; patient readmission