Breathlessness and exercise performance to predict mortality in long-term oxygen therapy - The population-based DISCOVERY study
Björklund, Filip LU
; Palm, Andreas
; Gorani, Jwan Abdulrazak
; Ahmadi, Zainab
LU
; Sundh, Josefin
; Theorell-Haglöw, Jenny
; Ljunggren, Mirjam
; Grote, Ludger
; Wadell, Karin
and Ekström, Magnus
LU
(2023)
In Respiratory Medicine
216.
- Abstract
BACKGROUND: Patients with chronic respiratory failure treated with long-term oxygen therapy (LTOT) often have severe breathlessness, impaired exercise performance, and high but variable mortality that is difficult to predict. We aimed to evaluate breathlessness and exercise performance upon starting LTOT as predictors of overall and short-term mortality.
METHODS: This was a longitudinal, population-based study of patients who initiated LTOT between 2015 and 2018 in Sweden. Breathlessness was measured using the Dyspnea Exertion Scale, and exercise performance using the 30s-Sit-To-Stand test. Associations with overall and three-month mortality were analyzed using Cox-regression. Subgroup analyses were performed for patients with... (More)
BACKGROUND: Patients with chronic respiratory failure treated with long-term oxygen therapy (LTOT) often have severe breathlessness, impaired exercise performance, and high but variable mortality that is difficult to predict. We aimed to evaluate breathlessness and exercise performance upon starting LTOT as predictors of overall and short-term mortality.
METHODS: This was a longitudinal, population-based study of patients who initiated LTOT between 2015 and 2018 in Sweden. Breathlessness was measured using the Dyspnea Exertion Scale, and exercise performance using the 30s-Sit-To-Stand test. Associations with overall and three-month mortality were analyzed using Cox-regression. Subgroup analyses were performed for patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) respectively. The predictive capacity of models was assessed using a C-statistic.
RESULTS: A total of 441 patients (57.6% female, aged 75.4 ± 8.3 years) were analyzed, of whom 141 (32%) died during a median follow-up of 260 (IQR 75-460) days. Both breathlessness and exercise performance were independently associated with overall mortality in the crude models, but only exercise performance remained independently associated with overall mortality when models were adjusted for other predictors, when short-term mortality was analyzed, or when breathlessness and exercise capacity were analyzed concurrently. The multivariable model including exercise performance but not breathlessness provided a relatively high predictive capacity for overall mortality, C-statistic 0.756 (95% CI 0.702-0.810). Similar results were seen in the COPD and ILD subgroups.
CONCLUSION: Exercise performance as measured by the 30s-STS may be useful to identify patients with higher mortality on LTOT for optimized management and follow-up.
(Less)
- author
- Björklund, Filip
LU
; Palm, Andreas
; Gorani, Jwan Abdulrazak
; Ahmadi, Zainab
LU
; Sundh, Josefin
; Theorell-Haglöw, Jenny
; Ljunggren, Mirjam
; Grote, Ludger
; Wadell, Karin
and Ekström, Magnus
LU
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Respiratory Medicine
- volume
- 216
- article number
- 107306
- publisher
- Elsevier
- external identifiers
-
- scopus:85161342765
- pmid:37286141
- ISSN
- 1532-3064
- DOI
- 10.1016/j.rmed.2023.107306
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.
- id
- 2f86c36a-8b54-48fe-b7b5-98b0a1511f99
- date added to LUP
- 2023-06-15 09:24:57
- date last changed
- 2024-04-19 22:50:17
@article{2f86c36a-8b54-48fe-b7b5-98b0a1511f99,
abstract = {{<p>BACKGROUND: Patients with chronic respiratory failure treated with long-term oxygen therapy (LTOT) often have severe breathlessness, impaired exercise performance, and high but variable mortality that is difficult to predict. We aimed to evaluate breathlessness and exercise performance upon starting LTOT as predictors of overall and short-term mortality.</p><p>METHODS: This was a longitudinal, population-based study of patients who initiated LTOT between 2015 and 2018 in Sweden. Breathlessness was measured using the Dyspnea Exertion Scale, and exercise performance using the 30s-Sit-To-Stand test. Associations with overall and three-month mortality were analyzed using Cox-regression. Subgroup analyses were performed for patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) respectively. The predictive capacity of models was assessed using a C-statistic.</p><p>RESULTS: A total of 441 patients (57.6% female, aged 75.4 ± 8.3 years) were analyzed, of whom 141 (32%) died during a median follow-up of 260 (IQR 75-460) days. Both breathlessness and exercise performance were independently associated with overall mortality in the crude models, but only exercise performance remained independently associated with overall mortality when models were adjusted for other predictors, when short-term mortality was analyzed, or when breathlessness and exercise capacity were analyzed concurrently. The multivariable model including exercise performance but not breathlessness provided a relatively high predictive capacity for overall mortality, C-statistic 0.756 (95% CI 0.702-0.810). Similar results were seen in the COPD and ILD subgroups.</p><p>CONCLUSION: Exercise performance as measured by the 30s-STS may be useful to identify patients with higher mortality on LTOT for optimized management and follow-up.</p>}},
author = {{Björklund, Filip and Palm, Andreas and Gorani, Jwan Abdulrazak and Ahmadi, Zainab and Sundh, Josefin and Theorell-Haglöw, Jenny and Ljunggren, Mirjam and Grote, Ludger and Wadell, Karin and Ekström, Magnus}},
issn = {{1532-3064}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Respiratory Medicine}},
title = {{Breathlessness and exercise performance to predict mortality in long-term oxygen therapy - The population-based DISCOVERY study}},
url = {{http://dx.doi.org/10.1016/j.rmed.2023.107306}},
doi = {{10.1016/j.rmed.2023.107306}},
volume = {{216}},
year = {{2023}},
}