Delayed access and survival in idiopathic pulmonary fibrosis: A cohort study

Rationale: Idiopathic pulmonary fibrosis is often initially misdiagnosed. Delays in accessing subspecialty care could lead to worse outcomes among those with idiopathic pulmonary fibrosis. Objectives: To examine the association between delayed access to subspecialty care and survival time in idiopathic pulmonary fibrosis. Methods: We performed a prospective cohort study of 129 adults whometAmericanThoracic Society criteria for idiopathicpulmonary 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. Measurements and Main Results: 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.Alonger 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. Conclusions: Delayedaccess to a tertiary care center is associatedwith 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.