Annual and post-exacerbation follow-up of COPD patients in clinical practice – a large population-based study in Sweden

Clinical Research Results Abstract Introduction: Swedish guidelines recommend that COPD patients on maintenance inhaled treatments should have a visit at least annually (regular follow-up), and patients should be offered an additional follow-up after a COPD exacerbation (post-exacerbation visit) (1). This study investigated COPD-related visit patterns in Sweden, both regular visits and post-exacerbation visits. Methods: In this observational cohort study, COPD patients (age >40 years) prescribed inhaled maintenance treatment between 2006-2017 were identified in primary care medical records and linked to nationwide data on hospital contacts and prescription drug collections. The index date was defined as the first collection of inhaled COPD maintenance treatment after the COPD diagnosis. Regular and post-exacerbation visits were estimated within 15-months after index, using the cumulative incidence function adjusted for competing risk. Results: A total of 19,857 patients (mean age 69 years, 57% females) were included. The overall probability of having a regular follow-up visit was 39.1% (Figure 1). In total, 76% of the patients experienced at least one COPD exacerbation during the study period. Among patients with exacerbations, the overall probability of having a COPD-related visit within 15 months after a severe exacerbation was 36.9%, whereas the probability was 28.4% after a moderate exacerbation (Figure 2). Of patients with an exacerbation, 77% experienced a second exacerbation within 15 months after the first. Over the study period, there was an increase in the probability of having at least one follow-up visit within 15 months after the index, from 17.4% in 2006 to 53.4% in 2017. Also, the probability of a post-exacerbation visit increased from 11.0% in 2006 to 38.3% in 2017. Discussion: Although COPD follow-up visits have become more frequent over the last decades, there is still room for significant improvement. Our findings highlight the gap between national guideline recommendations and real-world clinical practice for the management of COPD. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest Study sponsor: AstraZenecaGT and SdFL are employed by AstraZeneca. FW is employed at Statisticon a client of AstraZeneca. CJ received payments for educations and advisory boards from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, and Teva. BS received honoraria for educations, lectures and advisory boards from AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, GlaxoSmithKline, Novartis and Teva. HS received honoraria for educations and advisory boards from Boehringer Ingelheim, Novartis, AstraZeneca, Novartis, GlaxoSmithKline, Chiesi, and TEVA References and Clinical Trial Registry Information National Board of Health and Welfare. Nationella riktlinjer för astma och KOL, updated 2020. Available from: socialstyrelsen.se. Accessed July 2021.