129 Mind the gap: understanding differences between admission-associated mortality in interstitial lung disease and palliative care referrals

<h3>Background</h3> Interstitial lung disease (ILD) represents a heterogenous group of parenchymal lung diseases which result in hospitalisations secondary to a wide range of presentations. A sub-set of hospitalised patients meet criteria for an Acute Exacerbation of ILD (AE-ILD): a clinically and radiologically significant event causing deterioration of symptoms with new, bilateral ground glass changes which can be triggered or idiopathic. We sought to further understand the role hospitalisations play in disease trajectory and prognosis. <h3>Methods</h3> We undertook a multi-centre retrospective observational study of ICD-10 coded primary admissions for interstitial lung disease of patients ≥18 years old between 01.01.2017 and 31.12.2019 across four NHS trusts in the North West of England. The primary outcome was time to death from admission. AE-ILD was defined as clinical progression of symptoms for &lt;30 days with new bilateral ground-glass changes or having been labelled as AE-ILD during admission. <h3>Results</h3> 519 admission events met the inclusion criteria. 38 (7.3%) were excluded from analysis due to insufficient data. The incidence of AE-ILD in our admission cohort was 47.5% (227 admissions). A further 52.5% (251) of admissions were admitted for other reasons including: pneumonia, lower respiratory tract infection and pulmonary embolism. Mean survival following AE-ILD admission was 406.56 days (95% CI: 319.24 – 493.82) and for other admissions 769.55 days (95% CI: 654.04 – 885.96), with the survival difference statistically significant (p &lt;0.001). Overall, there was a 16.5% inpatient all-cause mortality and 39.1% all-cause mortality within 90 days. Despite this, just 11.9% of patients were referred for palliative care. <h3>Conclusions</h3> Hospitalisation events in ILD, especially those secondary to AE-ILD, appear significant and should prompt clinicians to consider long-term prognosis and holistic management strategies – including referrals to palliative care. Future guidelines at local and national level should consider multi-disciplinary input to optimise symptomatic and end-of-life care for this group of patients.