Postdischarge COVID-19 studies find benefits of home oxygen, risks of PTSD, medical complications

Recent studies focused on patients' status after hospitalization for COVID-19, one finding that outcomes with home oxygen were good, but others noting that post-traumatic stress disorder (PTSD), readmissions, and new diagnoses of medical conditions were common.

Most COVID-19 patients who were discharged from the ED or hospital on oxygen did well, according to a study published by JAMA Network Open on April 1. A total of 621 adult patients (24.0% ED, 76.0% inpatient) who were on at least 3 L of oxygen per minute and were stable without other indications for inpatient care were discharged from two large U.S. hospitals with oxygen equipment, education, and nursing telephone follow-up. Over a median of 26 days, the all-cause mortality rate was 1.3% and the 30-day readmission rate was 8.5%. The results show that this approach “may help optimize outcomes, by ensuring right care in the right place at the right time and preserving access to acute care during the COVID-19 pandemic,” the authors said.

Post-traumatic stress disorder (PTSD) was common after COVID-19, according to an Italian study published March 29 by the Journal of General Internal Medicine. Researchers called 115 patients who had been hospitalized, surveying them three months after discharge. They found that 10.4% met the criteria for PTSD and another 8.6% could receive a diagnosis of subthreshold PTSD. Multivariate regression analysis indicated that previous psychiatric diagnosis and obesity were risk factors, while male sex was a protective factor. “Clinicians treating COVID-19 should consider screening for PTSD at follow-up assessments in patients discharged from the hospital,” the authors said.

Risk of readmission and death was high after discharge in a retrospective study published by The BMJ on March 31. It compared 47,780 British patients hospitalized with COVID-19 and discharged alive to about 50 million matched controls. Over a mean follow-up of 140 days, 29.4% of the COVID-19 patients were readmitted and 12.3% died, rates which were 3.5 and 7.7 times greater, respectively, than among controls. The study also found increased diagnoses of respiratory disease, diabetes, and cardiovascular disease in the COVID-19 group. The difference between groups was greater in patients younger than age 70 years and in non-White patients compared to White patients. An accompanying editorial cited the study as evidence of the need for “rapid learning to understand what represents good multidisciplinary care [for these patients], informed by real world outcome data and patient experience.”

Plans for studying post-acute COVID-19 were described in an article published by Annals of Internal Medicine on March 30. It reported on a virtual workshop held by the NIH in December to summarize existing knowledge and to identify key knowledge gaps regarding later COVID-19 manifestations.

Advice on designing and implementing post-COVID-19 clinics was offered by a “How I Do It” article published by CHEST on March 30. Clinicians from two academic health systems described their clinics and provided a framework for other institutions to develop similar ones. They concluded that “development and implementation of multidisciplinary post-COVID clinics is feasible, even in systems with no existing infrastructure for post-ICU follow-up” and noted that common barriers include securing protected time and space, establishing workflows, and coordinating with primary care.