With great interest we read the recent contribution by Sharma and colleagues1 about the association between outpatient follow-up and reduced risk of relapse after hospital discharge in patients with chronic obstructive pulmonary disease (COPD). Nonetheless, after studying the article we believed that we should make some comments.
Our first comment is a methodological one. The authors have looked at the risk of emergency department visits and readmissions in the 30-day period after hospital discharge because most preventable readmissions occur within this time frame. However, it was recently demonstrated that exacerbations in COPD are not random events but cluster together in time such that there is a high-risk period for recurrence in the 8-week period after the initial exacerbation.2 Knowing this, we wondered if the conclusion from the study by Sharma et al1 remains the same if a 60-day follow-up period is applied.
Schermer TRJ, Lucas PJF, Heijdra YF. Relapse After Hospital Admission for COPD: Are Routine Outpatient Follow-up Visits the Way to Go?. Arch Intern Med. 2011;171(8):782-790. doi:10.1001/archinternmed.2011.145