ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Implementation of Guideline Recommendations and Outcomes in Patients with Idiopathic Pulmonary Fibrosis: Data from the IPF-PRO Registry
Session Title
TP26 - TP026 DIAGNOSIS, ASSESSMENT, AND PROGNOSIS OF FIBROTIC ILD
Abstract
A1867 - Implementation of Guideline Recommendations and Outcomes in Patients with Idiopathic Pulmonary Fibrosis: Data from the IPF-PRO Registry
Author Block: J. A. De Andrade1, T. Kulkarni2, M. L. Neely3, A. S. Hellkamp3, A. Hajari Case4, K. Guntupalli5, S. Bender6, C. S. Conoscenti6, L. D. Snyder3, on behalf of the IPF-PRO Registry investigators; 1Vanderbilt University School of Medicine, Nashville, TN, United States, 2University of Alabama at Birmingham, Birmingham, AL, United States, 3Duke Clinical Research Institute, Durham, NC, United States, Duke University Medical Center, Durham, NC, United States, 4Piedmont Heathcare, Atlanta, GA, United States, 5Baylor College of Medicine, Houston, TX, United States, 6Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States.
Rationale: International guidelines for the management of IPF were published in 2011 and updated in 2015. We investigated the extent to which these recommendations have been implemented at referral centers in the US and associations between implementation of these guidelines and clinical outcomes.Methods: The IPF-PRO Registry is a multicenter observational US registry of patients with IPF. We assessed the implementation of eight recommendations in clinical practice guidelines within the 6 months after enrollment: visit to a specialized clinic; pulmonary function testing; use of oxygen in patients with resting hypoxemia and patients with exercise-induced hypoxemia; referral for pulmonary rehabilitation; treatment of gastro-esophageal reflux disease; initiation of anti-fibrotic therapy; referral for lung transplant evaluation. An implementation score was calculated as the number of recommendations achieved divided by the number for which the patient was eligible. Associations between implementation score and outcomes were analyzed using logistic regression and Cox proportional hazards models.Results: Among 727 patients, median (25th percentile, 75th percentile) implementation score was 0.6 (0.5, 0.8). Patients with an implementation score >0.6 had greater disease severity at enrollment than those with a lower score based on prior hospitalizations, FVC % predicted, and DLco % predicted, and worse quality of life based on SGRQ total score, SF-12 physical component summary (PCS) score and EQ-5D visual analog scale. Only 6.3% of patients had all the recommendations that they were eligible for implemented. Implementation was lowest for referral for pulmonary rehabilitation and referral for lung transplant evaluation (Table). Patients with higher implementation scores were more likely to have a relative decline in DLco (mmol/min/kPa) ≥15%, absolute decline in DLco >15% predicted, or worsening in SF-12 PCS score by ≥5 in the 6 months after enrollment. In unadjusted models, patients with higher implementation scores had a greater risk of death, death or lung transplant, and hospitalization, but no significant associations were observed in adjusted models.Conclusions: Data from the IPF-PRO Registry suggested that recommendations made in management guidelines were more likely to be implemented in patients with IPF who had greater disease severity. When adjusted for disease severity, no association was found between implementation of management guidelines and clinical outcomes.
Author Block: J. A. De Andrade1, T. Kulkarni2, M. L. Neely3, A. S. Hellkamp3, A. Hajari Case4, K. Guntupalli5, S. Bender6, C. S. Conoscenti6, L. D. Snyder3, on behalf of the IPF-PRO Registry investigators; 1Vanderbilt University School of Medicine, Nashville, TN, United States, 2University of Alabama at Birmingham, Birmingham, AL, United States, 3Duke Clinical Research Institute, Durham, NC, United States, Duke University Medical Center, Durham, NC, United States, 4Piedmont Heathcare, Atlanta, GA, United States, 5Baylor College of Medicine, Houston, TX, United States, 6Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States.
Rationale: International guidelines for the management of IPF were published in 2011 and updated in 2015. We investigated the extent to which these recommendations have been implemented at referral centers in the US and associations between implementation of these guidelines and clinical outcomes.Methods: The IPF-PRO Registry is a multicenter observational US registry of patients with IPF. We assessed the implementation of eight recommendations in clinical practice guidelines within the 6 months after enrollment: visit to a specialized clinic; pulmonary function testing; use of oxygen in patients with resting hypoxemia and patients with exercise-induced hypoxemia; referral for pulmonary rehabilitation; treatment of gastro-esophageal reflux disease; initiation of anti-fibrotic therapy; referral for lung transplant evaluation. An implementation score was calculated as the number of recommendations achieved divided by the number for which the patient was eligible. Associations between implementation score and outcomes were analyzed using logistic regression and Cox proportional hazards models.Results: Among 727 patients, median (25th percentile, 75th percentile) implementation score was 0.6 (0.5, 0.8). Patients with an implementation score >0.6 had greater disease severity at enrollment than those with a lower score based on prior hospitalizations, FVC % predicted, and DLco % predicted, and worse quality of life based on SGRQ total score, SF-12 physical component summary (PCS) score and EQ-5D visual analog scale. Only 6.3% of patients had all the recommendations that they were eligible for implemented. Implementation was lowest for referral for pulmonary rehabilitation and referral for lung transplant evaluation (Table). Patients with higher implementation scores were more likely to have a relative decline in DLco (mmol/min/kPa) ≥15%, absolute decline in DLco >15% predicted, or worsening in SF-12 PCS score by ≥5 in the 6 months after enrollment. In unadjusted models, patients with higher implementation scores had a greater risk of death, death or lung transplant, and hospitalization, but no significant associations were observed in adjusted models.Conclusions: Data from the IPF-PRO Registry suggested that recommendations made in management guidelines were more likely to be implemented in patients with IPF who had greater disease severity. When adjusted for disease severity, no association was found between implementation of management guidelines and clinical outcomes.
