COVID-19 linked to higher readmission, death rates in days following discharge
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Patients hospitalized with COVID-19 had higher rates of readmission or death 10 days after discharge compared with those with pneumonia or heart failure, according to research published in JAMA.
After 60 days of discharge, however, the data showed that COVID-19 was associated with lower readmission and death rates.
“When compared with similar patients who were hospitalized for other serious conditions, we found that COVID-19 patients had better outcomes at 60 days, but there was a period of high risk within the first 10 days after discharge where these patients had worse outcomes,” John Donnelly, PhD, research investigator in the department of learning health sciences at the University of Michigan Medical School, told Healio Primary Care. “These findings contribute to the growing literature showing that recovery following COVID-19 can be a bumpy road.”
Donnelly and colleagues used data from the VA’s corporate Data Warehouse to evaluate index hospitalizations in veterans admitted to 132 Veterans Affairs hospitals from March 1 to June 1 and discharged through July 1. For comparison, they also examined data on patients hospitalized for heart failure and non-COVID-19 pneumonia from the Agency for Health Research and Quality’s Clinical Classification Software Refined diagnosis groupings.
The researchers found that of the 2,179 index hospitalizations for COVID-19, 31.1% of patients were treated in the ICU, 12.8% were placed on mechanical ventilation, 14.1% received vasopressors, and 81.5% survived to hospital discharge. Additionally, they determined that within 60 days of discharge, 19.9% of patients who survived to hospital discharge were readmitted and 9.1% died.
Among patients initially hospitalized for COVID-19 and were readmitted, 30.2% had COVID-19, 8.5% had sepsis, 3.1% had pneumonia and 3.1% had heart failure.
After excluding index hospitalizations for patients who died or who could not be matched to patients with COVID-19, the researchers assessed the outcomes of 1,799 patients with pneumonia and 3,505 patients with heart failure who survived to hospital discharge.
In matched comparisons, patients with COVID-19 had lower rates of readmission or death at 60 days compared with those with pneumonia (26.1% vs. 31.7%; P = .006) and those with heart failure (27% vs. 37%; P < .001).
Donnelly and colleagues determined, however, that within 10 days of hospital discharge, COVID-19 patients had higher rates of readmission or death compared to those with pneumonia (13.4% vs. 9.7%; P = .01) and those with heart failure (13.9% vs. 8.8%; P < .001).
“For someone being discharged after hospitalization for COVID-19, I think it makes sense to encourage getting in contact with a physician as quickly as possible in the event that something seems off to help patients and loved ones make decisions about the best course of treatment,” Donnelly said. “Given our findings, it may also make sense to discuss this in the context of the first 10 days after discharge being a period of very high risk for clinical deterioration.”