Remote monitoring of low-risk adults with COVID-19 linked to fewer hospital days

Key takeaways:

• Patients with COVID-19 being monitored remotely with home oxygen had fewer days in the hospital.
• Older patients monitored at home had longer ICU stays and higher odds for ICU admission or death.

Remote monitoring of patients with COVID-19 and exertional hypoxia treated with supplemental oxygen at home was linked to a lower number of days in the hospital, according to a research letter published in CHEST.

However, these patients, especially those aged 70 years or older, had higher odds for ICU admission or death, according to researchers.

“This ED program to triage low-risk patients with COVID-19 with exertional hypoxia to treatment at home with remote monitoring and low-level supplemental oxygen was associated with fewer hospital days but with an increase in ICU days and trend toward an increase in the composite outcome of death or ICU for patients triaged to home with COVID-19 remote patient monitoring with home oxygen (cRPM-O₂), driven by events that occurred among patients [at least] 70 years old,” Harris L. Carmichael, MD, assistant professor and hospitalist at Intermountain Medical Center and clinical assistant professor at Stanford Medicine, and colleagues wrote.

Through a retrospective cohort study, Carmichael and colleagues evaluated how the cRPM-O₂ program impacted hospitalization duration in patients who visited the ED while positive for COVID-19 with exertional hypoxia and had a COVID-19-associated hyperinflammation score of less than two.

In order to remotely monitor patients’ SpO₂/heart rate, a Bluetooth-enabled pulse oximeter was connected to an app on the phones of those participating in the cRPM-O₂ program (n = 233; mean age, 55.1 years; 52.8% women) before they left the ED. Over 14 days, researchers instructed these individuals to record these data two times or more each day so that technicians could monitor them 24/7.

According to researchers, patients in this remote monitoring program were told to come back to the ED after monitoring technicians saw new hypoxemia in their biometric data.

Outcomes of the program were compared against those of control patients (n = 522; mean age, 61.5 years; 51.9% women) who were fit for remote monitoring inclusion but had an inpatient ED admission.

During the monitoring period, researchers observed 39 (16.7%) ED admissions from the cRPM-O₂ program group, and the median time from ED visit to admission was 4 days (interquartile range, 2-6).

Compared with control patients, researchers found 2.27 fewer days in the hospital per patient (95% CI, 1.53-3.01) with the cRPM-O₂ program after accounting for age, sex, ethnicity/race, insurance provider, Charlson Comorbidity Index and lowest recorded oxygen saturation during index ED visit.

However, these patients had also higher odds for ICU admission and death combined (OR = 1.93; 95% CI, 0.94-3.95) and more days spent in the ICU (0.33 days; 95% CI, 0-0.65), both of which were clinically insignificant, according to researchers.

When evaluating only patients aged 70 years or older in both groups, researchers found that patients in the cRPM-O₂ group had longer ICU stays by 1.05 days (95% CI, 0.07-2) and heightened odds for ICU admission or death (OR = 5.44; 95% CI, 0.93-31.75) compared with control patients. Notably, fewer deaths occurred in the remote monitoring group (0 vs. 4). Both groups in this analysis showed similar hospitalization duration.

These results changed when assessing patients aged younger than 70 years. For example, the cRPM-O₂ group had a shorter hospital duration by 2.56 days (95% CI, 1.84-3.3) vs. the control group. Researchers found no significant changes/differences in length of ICU stay and odds for ICU admission or death between both groups in this analysis.

“ED triage of select patients with COVID-19 with isolated exertional hypoxia to home with low-flow supplemental oxygen plus remote monitoring is associated with fewer hospital days, and a net clinical benefit especially may be realized among patients [younger than] 70 years old,” Carmichael and colleagues wrote. “Appropriate risk assessment and treatment with cRPM-O₂ may be a strategy to improve hospital capacity safely. Future study of subgroups is warranted to ensure the safety of this approach.”