Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19: a descriptive cohort study within the OpenSAFELY platform

Abstract

BackgroundPatients with COVID-19 are thought to be at higher risk of cardiometabolic and pulmonary complications, but quantification of that risk is limited. We aimed to describe the overall burden of these complications in survivors of severe COVID-19.MethodsWorking on behalf of NHS England we used data from the OpenSAFELY platform linking primary care records to death certificate and hospital data. We constructed two cohorts: a COVID-19 cohort consisting of patients discharged following hospitalisation with COVID-19, and a comparison population of patients discharged following hospitalisation with pneumonia in 2019. Outcomes included DVT, PE, ischaemic stroke, MI, heart failure, AKI and new type 2 diabetes diagnosis. Outcome rates from hospital discharge were measured in each cohort, stratified by patient demographics and 30-day period. We fitted Cox regression models to estimate crude and age/sex adjusted hazard ratios comparing outcome rates between the two cohorts.ResultsAmongst the population of 31,569 patients discharged following hospitalisation with COVID-19, the highest rates were observed for heart failure (199.3; 95% CI: 191.8 - 207.1) and AKI (154.5; 95% CI: 147.9 - 161.4). Rates of DVT, heart failure, ischaemic stroke, MI, PE and diabetes were high over the four months post discharge, especially in the first month. Patterns were broadly similar to those seen in patients discharged with pneumonia but somewhat higher in the COVID-19 population for stroke (adj-HR 1.78; 95% CI: 1.53 - 2.08), PE (adj-HR 1.38; 95% CI: 1.21 - 1.58), MI (adj-HR 1.46; 95% CI: 1.20 - 1.76), AKI (adj-HR 1.27; 95% CI: 1.19 - 1.36) and T2DM (adj-HR 1.28; 95% CI: 1.08 - 1.50).ConclusionsIn this descriptive study of survivors of severe COVID-19, rates of the measured outcomes are at least as high, though in some cases slightly higher, than in patients discharged after hospitalisation with pneumonia. Further work is needed to identify what characteristics of COVID-19 patients put them at highest risk of adverse events.

Clinical coding of long COVID in English primary care: a federated analysis of 58 million patient records in situ using OpenSAFELY

“…Separately numerous cohort studies have reported an increased risk of serious cardiovascular and metabolic outcomes following hospitalisation with COVID 8,9 , and there are various prospective studies such as the Post-hospitalisation COVID-19 study (PHOSP) following up hospitalised patients over the next year 10 . Other studies have examined variation in clinical coding, with some finding that "poor" coding can lead to altered incidence estimates 11 , while others implicate the design of clinical software systems in influencing variation [12][13][14] .…”

S1-Leitlinie Post-COVID/Long-COVID

“…Auch im Vergleich zu Patienten mit durchgemachter Influenza-Pneumonie zeigen COVID-19-Patienten ein um ca. 30-50 % erhöhtes Risiko für Myokardinfarkte und Schlaganfälle in der post-akuten Phase[101]. Die Inzidenz neu auftretender kardiovaskulärer Komplikationen in den ersten 6 Monaten nach COVID-19 ist direkt assoziiert mit dem Schweregrad der Akuterkrankung.…”

Clinical coding of long COVID in English primary care: a federated analysis of 58 million patient records in situ using OpenSAFELY

“…The ONS COVID Infection Survey estimates prevalence of self-diagnosed long COVID at 13.7% 6 . Separately numerous cohort studies have reported an increased risk of serious cardiovascular and metabolic outcomes following hospitalisation with COVID 7,8 , and there are various prospective studies such as PHOSP following up hospitalised patients over the next year 9 .…”