We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Delayed access and survival in idiopathic pulmonary fibrosis: a cohort study.
- Authors
Lamas DJ; Kawut SM; Bagiella E; Philip N; Arcasoy SM; Lederer DJ; Lamas, Daniela J; Kawut, Steven M; Bagiella, Emilia; Philip, Nisha; Arcasoy, Selim M; Lederer, David J
- Abstract
<bold>Rationale: </bold>Idiopathic pulmonary fibrosis is often initially misdiagnosed. Delays in accessing subspecialty care could lead to worse outcomes among those with idiopathic pulmonary fibrosis.<bold>Objectives: </bold>To examine the association between delayed access to subspecialty care and survival time in idiopathic pulmonary fibrosis.<bold>Methods: </bold>We performed a prospective cohort study of 129 adults who met American Thoracic Society criteria for idiopathic pulmonary fibrosis evaluated at a tertiary care center. Delay was defined as the time from the onset of dyspnea to the date of initial evaluation at a tertiary care center. We used competing risk survival methods to examine survival time and time to transplantation.<bold>Measurements and Main Results: </bold>The mean age was 63 years and 76% were men. The median delay was 2.2 years (interquartile range 1.0–3.8 yr), and the median follow-up time was 1.1 years. Age and lung function at the time of evaluation did not vary by delay. A longer delay was associated with an increased risk of death independent of age, sex, forced vital capacity, third-party payer, and educational attainment (adjusted hazard ratio per doubling of delay was 1.3, 95% confidence interval 1.03 to 1.6). Longer delay was not associated with a lower likelihood of undergoing lung transplantation.<bold>Conclusions: </bold>Delayed access to a tertiary care center is associated with a higher mortality rate in idiopathic pulmonary fibrosis independent of disease severity. Early referral to a specialty center should be considered for those with known or suspected interstitial lung disease.
- Subjects
NEW York (State); DIAGNOSIS; HEALTH services accessibility; LONGITUDINAL method; MEDICAL errors; MEDICAL referrals; PULMONARY fibrosis; RESEARCH funding; SURVIVAL
- Publication
American Journal of Respiratory & Critical Care Medicine, 2011, Vol 184, Issue 7, p842
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201104-0668OC