Elderly patients with COPD require more health care than elderly heart failure patients do in a hospital-based home care setting

Figures & data

Figure 1 The Health Diary forms.

Table 1 Characteristics of the study sample CHF- versus COPD-subjects. Results are presented as mean ±1 SD (range) for continuous variables and percentage for categorical variables. P-values are from Chi-square test and Student’s t-test (P-value≥0.05)

	CHF (n=58)	COPD (n=36)	P-value
Age	83±7 (65–100)	75±6 (65–86)	<0.001
Women, n (%)	29 (50)	22 (61)	n.s.
12 months prior inclusion  Times hospitalized, all causes	3.1±1.5 (2–10)	3.4±1.8 (2–9)	n.s.
Current smokers, n (%)	2 (3)	10 (29)	<0.05
Ex-smokers, n (%)	31 (54)	25 (71)	n.s.
Never smokers, n (%)	25 (43)	0 (0)	<0.05
Pack-year	8±13 (0–59)	38±19 (1–100)	<0.001
BMI	27±5 (16–43)	24±6 (12–41)	<0.01
SAT (%)	95±3 (82–99)	90±6 (70–98)	<0.001
Subjects on LTOT, n (%)	0 (0)	7 (19)
CCI, mean (SD)	4.9 (2.3)	3.4 (2.0)	<0.001
CCI, n (%)  0–1	4 (7)	5 (14)	n.s.
2	4 (7)	9 (25)	<0.05
3	6 (10)	12 (33)	<0.05
≥4	44 (76)	10 (28)	<0.05
Subjects with COPD, n (%)	17 (29)	36 (100)
FEV1 (% predicted), COPD subjects only	58±18 (23–96)	39±15 (13–79)	<0.001
GOLD stage, n (%)  I–II	13 (76)	3 (8)	<0.05
III	3 (18)	7 (20)	n.s.
IV	1 (6)	26 (72)	<0.05
GOLD grade, n (%)  A–B	6 (35)	1 (3)	<0.05
C	0 (0)	0 (0.0)	n.s.
D	11 (65)	35 (97)	<0.05
Subjects with CHF, n (%)	58 (100)	22 (61)
NYHA-class, n (%)  3	46 (79)	20 (91)	<0.05
4	12 (21)	2 (9)	<0.05
WBC (ref: 3.5–8.8×10*9/L)	7.8±1.9 (4.2–12.4)	10.9±4.8 (5.6–32.7)	<0.001
hsCRP (ref: <10 mg/L)	14.7±16.3 (0.7–93)	29.1±58.9 (0.3–343)	n.s.
Hemoglobin (ref: 134–170 g/L)	127±17 (95–167)	130±17 (102–172)	n.s.
Creatinine (ref: 45–90 µmol/L)	134±63 (64–488)	83±30 (43–164)	<0.001
ProBNP (ref: <1800 ng/L)	6036±6232 (410–35,000)	–
25(OH)D (ref: ≥50 nmol/L)	–	60±28 (11–141)

Abbreviations: BMI, body mass index; CCI, Charlson Comorbidity Index; CHF, chronic heart failure; hs-CRP, high sensitivity C reactive protein; LTOT, long-term oxygen therapy; NYHA, New York Heart Association Functional Class; 25(OH)D, the stable metabolite of vitamin D; proBNP, B-type natriuretic protein; SAT, blood oxygen saturation; WBC, white blood cell count; n.s., not significant.

Table 2 Study performance. Results are presented as mean ±1 SD (range) for continuous variables and percentage for categorical variables. P-values are from Chi-square test and Student’s t-test (P-value≥0.05)

	CHF (n=58)	COPD (n=36)	P-value
Completed 12 study months, n (%)	32 (55)	19 (53)	n.s.
Did not complete 12 study months, n (%)	26 (45)	17 (47)	n.s.
Reasons behind early exclusion
Death, n (%)	16 (28)	13 (36)	n.s.
Deterioration, n (%)	6 (10)	2 (6)	n.s.
Change of residency, n (%)	4 (7)	2 (6)	n.s.
Study months
Total	484	280
Per study subject	8.4±4.5 (0–12)	7.8±4.8 (0–12)	n.s.

Abbreviations: CHF, chronic heart failure; n.s., not significant.

Table 3 Primary outcome; exacerbation frequency and home health care contacts. Results are presented as means ±1 SD (range) for continuous variables . P-values are from Student’s t-test (P-value ≥0.05)

	CHF^a (n=58)	COPD^b (n=36)	P-value
Disease-specific exacerbations per subject	0.8±0.9 (0–5)	3.2±2.7 (0–10)	<0.001
Home care visit per subject
By physician	8.0±4.5 (1–18)	11.2 ±7.9 (1–32)	<0.05
By nurse	28.8±18.8 (2–87)	41.6±49.4 (2–251)	n.s.
By physiotherapist	2.3±2.2 (0–9)	2.7±3.2 (0–12)	n.s.
By dietician	0.2±0.7 (0–4)	0.5±0.8 (0–3)	n.s.
By curator	0.0±0.1 (0–1)	0.9±2.1 (0–9)	n.s.
Total home care contacts (home visits & phone calls)	67.4±38.0 (5–187)	94.4±84.4 (3–334)	<0.05

Notes: ^aDemanding diuretics; ^b demanding antibiotics and/or steroids.

Abbreviations: CHF, chronic heart failure; n.s., not significant.

Figure 2 The figures illustrate exacerbations of (A) CHF and (B) COPD. A time span of 20 days is shown. Data are from the Health Diary system.

Table 4 Secondary outcome; times of hospitalization. Results are presented as means ±1 SD (range) for continuous variables and percentage for categorical variables. P-values are from Student’s t-test (P-value ≥0.05)

	CHF (n=58)	COPD (n=36)	P-value
Times hospitalized 12 months prior inclusion, all causes, per subject	3.1±1.5 (2–10)	3.4±1.8 (2–9)	n.s.
Times hospitalized during study period, all causes, per subject	0.8±1.3 (0–7)	1.2±1.5 (0–6)	n.s.
Assessable months in the study
Prior inclusion	696	432
During the study	484	280
% of planned study months	70	65
After adjustment for assessable months
-Times hospitalized prior inclusion, all causes, per subject	***2.1±1.1 (1.4–7)	**2.2±1.2 (1.3–5.8)	n.s.

***<0.001 vs “during study period”; **<0.01 vs “during study period”.

Abbreviations: CHF, chronic heart failure; COPD, chronic obstructive pulmonary disease; N.s., not significant.

Table 5 Hospitalization during study period specified as disease-specific – urgent or planned – or due to other causes. Results are presented as means ±1 SD (range). P-values are from Student’s t-test (P-value ≥0.05)

	CHF (n=58)	COPD (n=36)	P-value
Disease-specific hospitalization per subject, urgent	0.1±0.3 (0–1)	0.6±0.9 (0–4)	<0.01
Disease-specific hospitalization per subject, planned	0.0±0.1 (0–1)	0.2±0.6 (0–3)	n.s.
Hospitalization per subject due to other causes	0.7±1.3 (0–7)	0.5±1.0 (0–4)	n.s.

Abbreviations: CHF, chronic heart failure; n.s., not significant.

Table 6 Questions and results from the questionnaire concerning various symptoms, medication, and use of the digital pen (translated into English). All questions were responded from 1 = ”I do not agree” to 5 = ”I fully agree”

			1 Month		6 Months		12 Months
Question no.	Adapted from	Questions about symptoms, medication, and use of the digital pen	N	Mean ± SD (min-max)	N	Mean ± SD (min-max)	N	Mean ± SD (min-max)
1	Demiris et al, 2000,^Citation14 question 12	The digital pen and health diary saves me time.	73	4.5±1.0 (1–5)	55	4.3±1.2 (1–5)	49	4.6±1.0 (1–5)
2	Bakken et al, 2006^Citation15	It was easy to learn to use the digital pen	75	5.0±0.3 (3–5)	53	4.9±0.3 (4–5)	47	4.8±0.6 (1–5)
3	Bakken et al, 2006^Citation15	I can always trust the digital pen to work	76	4.6±0.9 (2–5)	55	4.7±1.0 (1–5)	48	4.5±1.0 (1–5)
4	Lind & Karlsson, 2004^Citation16	It was easy to understand the health diary	74	4.7±0.7 (1–5)	52	4.8±0.7 (2–5)	48	4.9±0.5 (2–5)
5	Demiris et al, 2000,^Citation14 question 2	The digital pen can violate my privacy	78	1.5±1.1 (1–5)	56	1.6±1.2 (1–5)	50	1.7±1.2 (1–5)
6	–	If I could use the digital pen and health diary in the future I would like to	76	4.4±1.2 (1–5)	56	4.3±1.3 (1–5)	48	4.4±1.3 (1–5)
7	Bakken et al, 2006^Citation15	I am more involved in my care when using the digital pen and health diary	78	4.5±1.0 (1–5)	55	4.5±1.0 (1–5)	49	4.6±1.0 (1–5)
8	Bakken et al, 2006^Citation15	My health care professionals use information from the digital pen and health diary during home visits or telephone follow-ups	77	4.8±0.6 (1–5)	55	4.8±0.7 (1–5)	48	4.9±0.6 (1–5)
9	Demiris et al, 2000,^Citation14 question 1	My health care professionals can get a good understanding of my medical problem through the digital pen and health diary	77	4.7±0.9 (1–5)	54	4.8±0.6 (2–5)	49	4.6±0.9 (1–5)
10	Demiris et al, 2000,^Citation14 question 7	The digital pen and health diary save time for my health care professionals	74	4.8±0.6 (1–5)	55	4.7±0.8 (1–5)	49	4.7±0.9 (1–5)
11	Demiris et al, 2000,^Citation14 question 19	The digital pen and health diary make it easier for me to contact my health care professionals	74	4.8±0.6 (3–5)	55	4.6±1.0 (1–5)	49	4.7±0.8 (1–5)
12	Bakken et al, 2006^Citation15	My health is better than it was before I used the digital pen and health diary	75	3.4±1.5 (1–5)	56	3.9±1.3 (1–5)	49	3.6±1.4 (1–5)
13	–	I learn more about my disease when using the digital pen and health diary	77	3.4±1.4 (1–5)	56	3.8±1.4 (1–5)	49	3.7±1.4 (1–5)
14	–	I feel more secure when reporting using the digital pen and health diary	77	4.5±1.0 (1–5)	56	4.7±0.9 (1–5)	49	4.6±0.9 (1–5)
15	Bakken et al, 2006^Citation15	I follow my health care professionals’ advice better when I use the pen and health diary	77	4.5±1.0 (1–5)	56	4.5±0.9 (1–5)	49	4.5±1.0 (1–5)

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