Association of Treatment with Remdesivir and 30-day Hospital Readmissions in Patients Hospitalized with COVID-19

Finn, Arkadiy; Jindal, A.K.; Andrea, Sarah B.; Selvaraj, Vijairam; Dapaah-Afriyie, Kwame

doi:10.1016/j.amjms.2022.01.021

Cited by 11 publications

(17 citation statements)

References 20 publications

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“…Data from ACTT-1 indicated a higher rate of readmission among patients assigned to remdesivir as compared with placebo (5% vs 2%) but the trial was underpowered to detect significant differences in this outcome [ 4 ]. Few observational studies have indicated a potential benefit of remdesivir on readmission rates [ 10 , 15–17 ]. A study using data from the National Veterans Affairs Healthcare System demonstrated significantly reduced risk of 30-day readmission in multiple comparative analyses including propensity-score-quintile adjusted analyses (hazard ratio [HR]: 0.80; 95% CI: 0.72–0.89), propensity-score-matched analyses (HR: 0.83; 95% CI: 0.71–0.97) and inverse probability of treatment weighting analyses (HR: 0.96; 95% CI: 0.78–0.94) [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the ACTT-1 randomized controlled trial, 5% of patients in the remdesivir group were readmitted to the hospital, as compared with 3% in the placebo group, but this difference was not statistically significant (difference: 2%; 95% CI: 0%–4%) [ 4 ]. A previous observational study conducted among patients hospitalized for COVID-19 in Rhode Island between 1 April 2020 and 31 December 2020 demonstrated a significant association between remdesivir and 30-day readmission among patients hospitalized with mild disease (relative risk [RR]: 0.31; 95% CI: 0.13–0.75) but not reaching significance among the overall study cohort (RR: 0.81; 95% CI: 0.59–1.13) [ 10 ]. Given the emergence of new variants of concern and improvements in COVID-19 management, it is important to examine the association between remdesivir and readmission across the evolving pandemic in datasets sufficiently large to support the analysis.…”

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confidence: 99%

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Treatment of patients hospitalized for COVID-19 with remdesivir is associated with lower likelihood of 30-day readmission: a retrospective observational study

Mozaffari,

Chandak,

Gottlieb

et al. 2024

J. Comp. Eff. Res.

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Aim: This observational study investigated the association between remdesivir treatment during hospitalization for COVID-19 and 30-day COVID-19-related and all-cause readmission across different variants time periods. Patients & methods: Hospitalization records for adult patients discharged from a COVID-19 hospitalization between 1 May 2020 to 30 April 2022 were extracted from the US PINC AI Healthcare Database. Likelihood of 30-day readmission was compared among remdesivir-treated and nonremdesivir-treated patients using multivariable logistic regression models adjusted for age, corticosteroid treatment, Charlson comorbidity index and intensive care unit stay during the COVID-19 hospitalization. Analyses were stratified by maximum supplemental oxygen requirement and variant time period (pre-Delta, Delta and Omicron). Results: Of the 440,601 patients discharged alive after a COVID-19 hospitalization, 248,785 (56.5%) patients received remdesivir. Overall, remdesivir patients had a 30-day COVID-19-related readmission rate of 3.0% and all-cause readmission rate of 6.3% compared with 5.4% and 9.1%, respectively, for patients who did not receive remdesivir during their COVID-19 hospitalization. After adjusting for demographics and clinical characteristics, remdesivir treatment was associated with significantly lower odds of 30-day COVID-19-related readmission (odds ratio 0.60 [95% confidence interval: 0.58–0.62]), and all-cause readmission (0.73 [0.72–0.75]). Significantly lower odds of 30-day readmission in remdesivir-treated patients was observed across all variant time periods. Conclusion: Treating patients hospitalized for COVID-19 with remdesivir is associated with a statistically significant reduction in 30-day COVID-19-related and all-cause readmission across variant time periods. These findings indicate that the clinical benefit of remdesivir may extend beyond the COVID-19 hospitalization.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Treatment of patients hospitalized for COVID-19 with remdesivir is associated with lower likelihood of 30-day readmission: a retrospective observational study

Mozaffari,

Chandak,

Gottlieb

et al. 2024

J. Comp. Eff. Res.

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“…Several observational studies of COVID-19 patient readmission did not consider COVID-19–directed therapies as a potential risk factor . However, 1 observational study showed a trend toward fewer readmissions among patients who received remdesivir while 2 studies from Spain identified glucocorticoid use as a risk factor for readmissions …”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25] However, 1 observational study showed a trend toward fewer readmissions among patients who received remdesivir while 2 studies from Spain identified glucocorticoid use as a risk factor for readmissions. [26][27][28] The lack of association of delayed recognition of treatment eligibility with mortality and length of stay may be due to the focus on an exposure that is occurring relatively early in the hospital course, the relative clinical impact of different COVID-19 directed therapies, and individual variability of pulse oximeter accuracy throughout the hospital stay. 29 The trend toward shorter length of stay and lower in-hospital mortality were likewise relatively small and would appear to contradict prior studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19

Fawzy,

Wu,

Wang

et al. 2023

JAMA Netw Open

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ImportanceMany pulse oximeters have been shown to overestimate oxygen saturation in persons of color, and this phenomenon has potential clinical implications. The relationship between overestimation of oxygen saturation with timing of COVID-19 medication delivery and clinical outcomes remains unknown.ObjectiveTo investigate the association between overestimation of oxygen saturation by pulse oximetry and delay in administration of COVID-19 therapy, hospital length of stay, risk of hospital readmission, and in-hospital mortality.Design, Setting, and ParticipantsThis cohort study included patients hospitalized for COVID-19 at 186 acute care facilities in the US with at least 1 functional arterial oxygen saturation (SaO2) measurement between March 2020 and October 2021. A subset of patients were admitted after July 1, 2020, without immediate need for COVID-19 therapy based on pulse oximeter saturation (SpO2 levels of 94% or higher without supplemental oxygen).ExposuresSelf-reported race and ethnicity, difference between concurrent SaO2 and pulse oximeter saturation (SpO2) within 10 minutes, and initially unrecognized need for COVID-19 therapy (first SaO2 reading below 94% despite SpO2 levels of 94% or above).Main Outcome and MeasuresThe association of race and ethnicity with degree of pulse oximeter measurement error (SpO2 − SaO2) and odds of unrecognized need for COVID-19 therapy were determined using linear mixed-effects models. Associations of initially unrecognized need for treatment with time to receipt of therapy (remdesivir or dexamethasone), in-hospital mortality, 30-day hospital readmission, and length of stay were evaluated using mixed-effects models. All models accounted for demographics, clinical characteristics, and hospital site. Effect modification by race and ethnicity was evaluated using interaction terms.ResultsAmong 24 504 patients with concurrent SpO2 and SaO2 measurements (mean [SD] age, 63.9 [15.8] years; 10 263 female [41.9%]; 3922 Black [16.0%], 7895 Hispanic [32.2%], 2554 Asian, Native American or Alaskan Native, Hawaiian or Pacific Islander, or another race or ethnicity [10.4%], and 10 133 White [41.4%]), pulse oximetry overestimated SaO2 for Black (adjusted mean difference, 0.93 [95% CI, 0.74-1.12] percentage points), Hispanic (0.49 [95% CI, 0.34-0.63] percentage points), and other (0.53 [95% CI, 0.35-0.72] percentage points) patients compared with White patients. In a subset of 8635 patients with a concurrent SpO2 − SaO2 pair without immediate need for COVID-19 therapy, Black patients were significantly more likely to have pulse oximetry values that masked an indication for COVID-19 therapy compared with White patients (adjusted odds ratio [aOR], 1.65; 95% CI, 1.33-2.03). Patients with an unrecognized need for COVID-19 therapy were 10% less likely to receive COVID-19 therapy (adjusted hazard ratio, 0.90; 95% CI, 0.83-0.97) and higher odds of readmission (aOR, 2.41; 95% CI, 1.39-4.18) regardless of race (P for interaction = .45 and P = .14, respectively). There was no association of unrecognized need for COVID-19 therapy with in-hospital mortality (aOR, 0.84; 95% CI, 0.71-1.01) or length of stay (mean difference, −1.4 days; 95% CI, −3.1 to 0.2 days).Conclusions and RelevanceIn this cohort study, overestimation of oxygen saturation by pulse oximetry led to delayed delivery of COVID-19 therapy and higher probability of readmission regardless of race. Black patients were more likely to have unrecognized need for therapy with potential implications for population-level health disparities.

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“…Patients require a multisystemic approach and commonly need hospital readmission. RWE has shown that previous RDV treatment showed superior results based on the need for readmission during a 30-day follow-up [ 36 ], especially among those with milder disease (RR: 0.31; 95% CI: 0.13, 0.75) [ 37 ]. In a real-world cohort analysis of individuals hospitalized with COVID-19 who were admitted to the ICU, those treated with RDV had reduced hospital readmission risk at 30, 60, and 90 days, irrespective of the predominant circulating SARS-CoV-2 variant [ 38 ].…”

Section: Remdesivir Outcomesmentioning

confidence: 99%

Remdesivir Use in the Real-World Setting: An Overview of Available Evidence

Akinosoglou,

Rigopoulos,

Schinas

et al. 2023

Viruses

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In the years of Coronavirus Disease 2019 (COVID-19), various treatment options have been utilized. COVID-19 continues to circulate in the global population, and the evolution of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has posed significant challenges to the treatment and prevention of infection. Remdesivir (RDV), an anti-viral agent with in vitro efficacy against coronaviruses, is a potent and safe treatment as suggested by a plethora of in vitro and in vivo studies and clinical trials. Emerging real-world data have confirmed its effectiveness, and there are currently datasets evaluating its efficacy and safety against SARS-CoV-2 infections in various clinical scenarios, including some that are not in the SmPC recommendations according for COVID-19 pharmacotherapy. Remdesivir increases the chance of recovery, reduces progression to severe disease, lowers mortality rates, and exhibits beneficial post-hospitalization outcomes, especially when used early in the course of the disease. Strong evidence suggests the expansion of remdesivir use in special populations (e.g., pregnancy, immunosuppression, renal impairment, transplantation, elderly and co-medicated patients) where the benefits of treatment outweigh the risk of adverse effects. In this article, we attempt to overview the available real-world data of remdesivir pharmacotherapy. With the unpredictable course of COVID-19, we need to utilize all available knowledge to bridge the gap between clinical research and clinical practice and be sufficiently prepared for the future.

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Association of Treatment with Remdesivir and 30-day Hospital Readmissions in Patients Hospitalized with COVID-19

Cited by 11 publications

References 20 publications

Treatment of patients hospitalized for COVID-19 with remdesivir is associated with lower likelihood of 30-day readmission: a retrospective observational study

Treatment of patients hospitalized for COVID-19 with remdesivir is associated with lower likelihood of 30-day readmission: a retrospective observational study

Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19

Remdesivir Use in the Real-World Setting: An Overview of Available Evidence

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