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Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19 in England: a descriptive cohort
, John Tazare1, Alex J Walker2
1London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
Insights
Patients hospitalized with COVID-19 face significantly higher risks of cardiometabolic and pulmonary issues post-discharge compared to the general population. However, these risks are comparable to those following pneumonia hospitalization, indicating a substantial healthcare burden.
Area of Science:
- Public Health
- Epidemiology
- Cardiology
- Pulmonology
- Endocrinology
Background:
- Limited quantification exists for cardiometabolic and pulmonary complications in COVID-19 survivors post-hospitalization.
- Assessing the post-discharge risk burden is crucial for managing long-term health consequences of COVID-19.
Purpose of the Study:
- To quantify the risk of specific cardiometabolic and pulmonary complications in patients discharged after COVID-19 hospitalization.
- To compare these risks against a pre-pandemic pneumonia cohort and a general population cohort.
Main Methods:
- Utilized linked primary care, death certificate, and hospital data from the OpenSAFELY platform for 77,347 COVID-19 survivors.
- Constructed three cohorts: COVID-19 discharge, pre-pandemic pneumonia discharge, and a 2019 general population control.
- Studied outcomes including DVT, PE, ischemic stroke, MI, heart failure, AKI, and new T2DM diagnosis using Fine and Gray models.
Main Results:
- COVID-19 survivors exhibited markedly higher risks for all studied outcomes compared to the general population.
- Risks peaked in the first month post-discharge and declined over the subsequent four months.
- Compared to pneumonia survivors, COVID-19 patients had similar overall outcome risks, but a higher risk of new type 2 diabetes mellitus (T2DM).
Conclusions:
- Hospitalization for COVID-19 significantly elevates the risk of adverse cardiometabolic and pulmonary outcomes post-discharge.
- The excess risk profile following COVID-19 discharge is comparable to that of pneumonia discharge.
- These findings highlight a substantial additional burden on healthcare resources due to long-term COVID-19 complications.
Abstract:
Background: Patients surviving hospitalisation for COVID-19 are thought to be at high risk of cardiometabolic and pulmonary complications, but quantification of that risk is limited. We aimed to describe the overall burden of these complications in people after discharge from hospital with COVID-19. Methods: Working on behalf of NHS England, we used linked primary care records, death certificate and hospital data from the OpenSAFELY platform. We constructed three cohorts: patients discharged following hospitalisation with COVID-19, patients discharged following pre-pandemic hospitalisation with pneumonia, and a frequency-matched cohort from the general population in 2019. We studied seven outcomes: deep vein thrombosis (DVT), pulmonary embolism (PE), ischaemic stroke, myocardial infarction (MI), heart failure, AKI and new type 2 diabetes mellitus (T2DM) diagnosis. Absolute rates were measured in each cohort and Fine and Gray models were used to estimate age/sex adjusted subdistribution hazard ratios comparing outcome risk between discharged COVID-19 patients and the two comparator cohorts. Results: Amongst the population of 77,347 patients discharged following hospitalisation with COVID-19, rates for the majority of outcomes peaked in the first month post-discharge, then declined over the following four months. Patients in the COVID-19 population had markedly higher risk of all outcomes compared to matched controls from the 2019 general population. Across the whole study period, the risk of outcomes was more similar when comparing patients discharged with COVID-19 to those discharged with pneumonia in 2019, although COVID-19 patients had higher risk of T2DM (15.2 versus 37.2 [rate per 1,000-person-years for COVID-19 versus pneumonia, respectively]; SHR, 1.46 [95% CI: 1.31 - 1.63]). Conclusions: Risk of cardiometabolic and pulmonary adverse outcomes is markedly raised following discharge from hospitalisation with COVID-19 compared to the general population. However, excess risks were similar to those seen following discharge post-pneumonia. Overall, this suggests a large additional burden on healthcare resources.
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