First 10 Days After Leaving Hospital Carry High Risk for COVID-1 street01200032021-03-20 22:32:29
First 10 Days After Leaving Hospital Carry High Risk for COVID-19 Patients
December 14, 2020 11:36 AM University of Michigan
Comparison with heart failure and pneumonia patients shows much different pattern of 60-day readmission to hospital or death.
In the first months after their COVID-19 hospital stay, patients faced a high risk of ongoing health problems, trips back to the hospital, and death, a growing number of studies has shown.
But the first week and a half may be especially dangerous, according to a new study in JAMA by a team from the University of Michigan and VA Ann Arbor Healthcare System.
COVID-19 patients had a 40% to 60% higher risk of ending up back in the hospital or dying in the first 10 days, compared with similar patients treated at the same hospitals during the same months for heart failure or pneumonia.
By the end of 60 days, the COVID-19 patients’ overall risk of readmission or death was lower than that for the other two serious conditions.
Even so, in the first two months, 9% of the COVID-19 patients who survived hospitalization had died, and almost 20% had suffered a setback that sent them back to the hospital.
That’s on top of the 18.5% who had died during their hospitalization.
//Curve shows combined outcome of death or readmission to hospital differed over time for patients discharged in spring/summer.//
The researchers compared post-hospital outcomes for nearly 2,200 veterans who survived their hospitalization at 132 VA hospitals for COVID-19 this spring and early summer, with outcomes for nearly 1,800 similar patients who survived a stay for pneumonia that wasn’t related to COVID-19, and 3,500 who survived a heart failure-related stay, during the same time.
With hundreds of thousands of Americans now hospitalized for severe cases of COVID-19, and hospitals working to free up beds for an ongoing surge, the study suggests a need for special vigilance in the first days after discharge, says John P. Donnelly, Ph.D., M.S.P.H., M.S., the study’s first author and an epidemiologist in the Department of Learning Health Sciences at Michigan Medicine, U-M’s academic medical center.
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“By comparing COVID-19 patients’ long-term outcomes with those of other seriously ill patients, we see a pattern of even greater-than-usual risk right in the first one to two weeks, which can be a risky period for anyone,” says Donnelly, who is a scholar in a special training program for critical illness data researchers at the U-M Institute for Healthcare Policy and Innovation. “Now, the question is what to do about it. How can we design better discharge plans for these patients? How can we tailor our communication and post-hospital care to their needs? And how can we help their caregivers prepare and cope?”
More about the study
Donnelly worked on the study with Michigan Medicine and VAAHS critical care physicians Hallie Prescott, M.D., M.Sc., and Theodore Iwashyna, M.D., Ph.D. Prescott is senior author of another recent paper showing slow recovery in COVID-19 patients hospitalized in Michigan hospitals during the state’s spring surge.
"By comparing COVID-19 patients’ long-term outcomes with those of other seriously ill patients, we see a pattern of even greater-than-usual risk right in the first one to two weeks, which can be a risky period for anyone."
“Unfortunately,” says Iwashyna, “this is yet more evidence that COVID-19 is not ‘one and done.’ For many patients, COVID-19 seems to set off cascades of problems that are every bit as serious as those we see in other diseases. But too little of our healthcare response — and too little research — is designed to help these patients as they continue for days, weeks, even months to recover from COVID-19.”