title: Comorbidity associated with referral to pulmonary rehabilitation in people hospitalized with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Comorbid conditions are common in people with chronic obstructive pulmonary disease (COPD) and may affect therapeutic management. The aim of this study was to examine the association of comorbidity in people with COPD with referral to a pulmonary rehabilitation (PR) program.
  
  
  METHODS
  An analysis of data was conducted from an observational study of 88 people admitted to hospital with a primary diagnosis of COPD. Demographic and admission-related data were extracted and comorbidity scores (Charlson and Rx-Risk-V) were calculated.
  
  
  RESULTS
  Total comorbidity scores were not associated with referral to PR; however specific comorbid conditions were. The presence of anxiety (from medical records) was more frequent in those referred to PR (χ = 4.20; P = .04; OR, 7.0; 95% CI, 0.8-59.0). The presence of hypertension (as determined by Rx-Risk-V) was more likely to result in PR referral (χ = 6.69; P = .01; OR, 6.8; 95% CI, 1.6-29.1), and, in those with arrhythmia, PR referral was less likely (χ = 4.22; P = .04; OR, 0.28; 95% CI, 0.08-0.99). Patients who had been referred to PR had lower forced expiratory volume in 1 second (FEV1 percent predicted) (P < .001) and greater hospital bed days in previous 3 years (P = .051). In a multivariate analysis, FEV1 percent predicted, bed days in the last 3 years, and Rx-Risk-V categories of hypertension and arrhythmia accounted for 25% of variance in referral to PR.
  
  
  CONCLUSIONS
  In addition to COPD disease severity and hospital utilization, specific comorbidities identified with a comprehensive system (ie, the Rx-Risk score) were associated with referral to PR in this sample.
authors.affiliation: School of Health Sciences (Ms Li and Dr Johnston), and School of Pharmacy and Medical Sciences (Dr Caughey), University of South Australia, Adelaide, Australia.
authors.forename: Lok Sze Katrina
authors.initials: LS
authors.lastname: Li
authors.forename: Gillian
authors.initials: G
authors.lastname: Caughey
authors.forename: Kylie
authors.initials: K
authors.lastname: Johnston
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000534:rehabilitation*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012720:Severity of Illness Index