Continuing Cardiopulmonary Symptoms, Disability, and Financial Toxicity 1 Month After Hospitalization for Third‐Wave COVID‐19: Early Results From a US Nationwide Cohort

Abstract

BACKGROUND: Patients discharged after COVID-19 report ongoing needs. OBJECTIVES: To measure incident symptoms after COVID-19 hospitalization. DESIGN, SETTING, AND PARTICIPANTS: Preplanned early look at 1-month follow-up surveys from patients hospitalized August 2020 to January 2021 in NHLBI PETAL Network’s Biology and Longitudinal Epidemiology: COVID-19 Observational (BLUE CORAL) study. English- or Spanish-speaking hospitalized adults without substantial pre-COVID-19 disability with a positive molecular test for SARS-CoV-2. RESULTS: Overall, 253 patients were hospitalized for a median of 5 days (interquartile range [IQR], 3-8), and had a median age of 60 years (IQR, 45-68). By race/ethnicity, 136 (53.8%) were non-Hispanic White, 23 (9.1%) were non-Hispanic Black, and 83 (32.8%) were Hispanic. Most (139 [54.9%]) reported a new or worsened cardiopulmonary symptom, and 16% (n = 39) reported new or increased oxygen use; 213 (84.2%) patients reported not feeling fully back to their pre-COVID-19 level of functioning. New limitations in activities of daily living were present in 130 (52.8%) patients. Financial toxicities, including job loss or change (49 [19.8%]), having a loved one take time off (93 [37.8%]), and using up one’s savings (58 [23.2%]), were common. Longer lengths of hospital stay were associated with greater odds of 1-month cardiopulmonary symptoms (adjusted odds ratio [aOR], 1.82 per additional week in the hospital; 95% CI, 1.11-2.98) and new disability (aOR, 2.06; 95% CI, 1.21-3.53). There were not uniform demographic patterns of association. LIMITATIONS: We prioritized patients’ reports of their own incident problems over objective testing. CONCLUSION: Patients who survived COVID-19 in the United States during late 2020/early 2021 still faced new burdens 1 month after hospital discharge.

Survival After Severe COVID-19: Long-Term Outcomes of Patients Admitted to an Intensive Care Unit

“…Moreover, the mean physical function score was less than one standard deviation below normal. In contrast to other studies, [7][8][9][10][11] we found evidence for debilitating physical and mental disability in only a small portion of our patient sample. The PROPr score was 0.46 (SD 0.3), which is worse than the mean PROPr score (0.52) observed in the US population; 44,50 however, this difference is less than the effect of chronic illness on PROPr (ie, emphysema 50 and dialysis 51 decrease PROPr by about −0.2).…”

“…1 While the acute phase of the illness has been well described, [2][3][4][5][6] the post-discharge outcomes of patients who were critically ill from COVID-19 has not been well-reported, particularly in the United States (U.S.). [7][8][9][10][11][12] As such, we sought to describe long-term outcomes of patients who required admission to an intensive care unit (ICU).…”

Disparities in the allocation of inpatient physical and occupational therapy services for patients with COVID‐19

“…Yet, studies of hospitalized COVID patients report longer‐term impairments often with new disabilities despite normal function at baseline. 8 These factors may impact a provider's clinical decision‐making surrounding referral to PT and/or OT as well as rehabilitation therapist's decisions on which patients to evaluate and/or treat at the bedside. Physical therapists and occupational therapists within acute care hospitals are often consulted to assist with discharge planning, especially for patients who may require placement and/or postacute care rehabilitation.…”

“… 3 , 4 , 5 Patients hospitalized for novel coronavirus (COVID‐19) infection experience fatigue, myalgias, respiratory symptoms, impaired physical function, and cognitive deficits, 6 , 7 and they are at high risk for new disability, with more than half reporting new disability and/or functional challenges at 1 month post hospitalization. 8 Increasing illness severity, especially amongst patients requiring mechanical ventilation, is associated with a greater likelihood of posthospital morbidity. 3 Thus, it is likely that many patients will develop significant deficits requiring rehabilitation during, and following, hospitalization.…”

Postacute Sequelae of COVID-19 Critical Illness

“…79 Consequently, loss of income is common, reported in 71% of ICU survivors in the year following critical illness, 86 as are other elements of financial toxicity, such as loss of health care coverage, depletion of savings, and medical bills. [86][87][88] Family structure and roles may be also altered, as one-quarter of ICU survivors report needing a caregiver 1 year after critical illness. The vast majority of care is provided by family members, half of whom report a resultant negative impact on employment.…”