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Observational Study
. 2020 Dec 18;18(1):408.
doi: 10.1186/s12916-020-01856-8.

Increased care at discharge from COVID-19: The association between pre-admission frailty and increased care needs after hospital discharge; a multicentre European observational cohort study

A Vilches-Moraga  1   2 , A Price  2 , P Braude  3 , L Pearce  1   2 , R Short  4 , A Verduri  5 , M Stechman  6 , J T Collins  7 , E Mitchell  3 , A G Einarsson  8 , S J Moug  9 , T J Quinn  10 , B Stubbs  11 , K McCarthy  3 , P K Myint  12 , J Hewitt  13 , B Carter  14 ; COPE Study
Collaborators, Affiliations
Observational Study

Increased care at discharge from COVID-19: The association between pre-admission frailty and increased care needs after hospital discharge; a multicentre European observational cohort study

A Vilches-Moraga et al. BMC Med. .

Abstract

Background: The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19.

Methods: Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease.

Results: Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58-81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6-24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1-3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97-4.11); CFS 5, 3.77 (1.94-7.32); CFS 6, 4.04 (2.09-7.82); CFS 7, 2.16 (1.12-4.20); and CFS 8, 3.19 (1.06-9.56).

Conclusions: Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.

Keywords: COVID-19; Care need; Clinical frailty scale; Discharge destination; Frailty; Increased care need; Older people.

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Conflict of interest statement

No conflict of interest exists for any of the authors.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
See this image and copyright information in PMC

References

    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3. - DOI - PMC - PubMed
    1. Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy [published online ahead of print, 2020 Apr 6] JAMA. 2020;323(16):1574–1581. doi: 10.1001/jama.2020.5394. - DOI - PMC - PubMed
    1. Docherty A, Harrison E, Green C, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characteristics Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. doi: 10.1136/bmj.m1985. - DOI - PMC - PubMed
    1. Department of Health and Social Care . Hospital discharge service: policy and operating model. 2020.
    1. After-care needs of inpatients recovering from COVID-19. NHS England and NHS Improvement coronavirus. 5th June 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/... (last retrieved August 1st 2020).

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