ABSTRACT
BACKGROUND: Most older adults hospitalized with COVID-19 survive their acute illness. The impact of COVID-19 hospitalization on patient-centered outcomes, including physical function, cognition, and symptoms, is not well understood. To address this knowledge gap, we collected longitudinal data about these issues from a cohort of older survivors of COVID-19 hospitalization. METHODS: We undertook a prospective study of community-living persons age ≥ 60 years who were hospitalized with COVID-19 from June 2020-June 2021. A baseline interview was conducted during or up to 2 weeks after hospitalization. Follow-up interviews occurred at one, three, and six months post-discharge. Participants completed comprehensive assessments of physical and cognitive function, symptoms, and psychosocial factors. An abbreviated assessment could be performed with a proxy. Additional information was collected from the electronic health record. RESULTS: Among 341 participants, the mean age was 71.4 (SD 8.4) years, 51% were women, and 37% were of Black race or Hispanic ethnicity. Median length of hospitalization was 8 (IQR 6-12) days. All but 4% of participants required supplemental oxygen, and 20% required care in an intensive care unit or stepdown unit. At enrollment, nearly half (47%) reported at least one preexisting disability in physical function, 45% demonstrated cognitive impairment, and 67% were pre-frail or frail. Participants reported a mean of 9 of 14 (SD 3) COVID-19-related symptoms. At the six-month follow-up interview, more than a third of participants experienced a decline from their pre-hospitalization function, nearly 20% had cognitive impairment, and burdensome symptoms remained highly prevalent. CONCLUSIONS: We enrolled a diverse cohort of older adults hospitalized with COVID-19 and followed them after discharge. Functional decline was common, and there were high rates of persistent cognitive impairment and symptoms. Future analyses of these data will advance our understanding of patient-centered outcomes among older COVID-19 survivors.
Subject(s)
COVID-19 , Humans , Female , Aged , Male , COVID-19/epidemiology , Patient Discharge , Prospective Studies , Aftercare , HospitalizationABSTRACT
BACKGROUND: Participation in ambulatory cardiac rehabilitation remains low, especially among older adults. Although mobile health cardiac rehabilitation (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments may limit older adults' uptake, and efficacy data are currently lacking. OBJECTIVE: This study aims to describe the design of the rehabilitation using mobile health for older adults with ischemic heart disease in the home setting (RESILIENT) trial. METHODS: RESILIENT is a multicenter randomized clinical trial that is enrolling patients aged ≥65 years with ischemic heart disease in a 3:1 ratio to either an intervention (mHealth-CR) or control (usual care) arm, with a target sample size of 400 participants. mHealth-CR consists of a commercially available mobile health software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcome is a change in functional mobility (6-minute walk distance), which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand the characteristics that determine different patterns of use (eg, persistent high engagement and declining engagement). RESULTS: As of December 2021, the RESILIENT trial had enrolled 116 participants. Enrollment is projected to continue until October 2023. The trial results are expected to be reported in 2024. CONCLUSIONS: The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains and characteristics that determine the sustained use of mHealth-CR. These findings will help design future precision medicine approaches to mobile health implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic that has shifted much of health care to a remote, internet-based setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/ct2/show/NCT03978130. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32163.
ABSTRACT
We sought to determine the associations between hemoglobin A1c (A1c) and admission glucose with in-hospital mortality among patients with diabetes mellitus (DM) hospitalized with COVID-19. Adults hospitalized between 3/5/20 and 12/1/20 in a Connecticut health care system were included if they had prior DM diagnosis, an in-hospital A1c, and a positive RT-PCR nasopharyngeal swab for SARS-CoV-2. A1c was stratified into <7%, 7-<9%, and ≥9%. Both bivariate and multi-variable adjusted logistic regression analyses were performed to determine the association of A1c categories and admission glucose >200 mg/dL with mortality (in-hospital death or transition to hospice) and with intensive care unit (ICU) use. Models were adjusted for demographics and 8 relevant comorbidities. Among 733 patients (median age 67 years [interquartile range, 56-77], 48.3% female, 43.11% White, 35.47% Black, 24.97% Hispanic, 1.64% Asian), 31.7% had A1c <7%, 40.5% 7-<9%, 27.8% ≥9%, and 38.1% admission glucose >200 mg/dL. During hospitalization, 111 (15.1%) patients died or transitioned to hospice and 230 (31.4%) required ICU care. In 2 multi-variable adjusted analyses, neither A1c category nor high admission glucose were significantly associated with mortality (A1c 7-<9%: OR 0.89, 95% CI 0.53-1.49;A1c >9% OR 1.3, CI 0.72-2.35 compared with A1c <7%;glucose >200 OR 1.34, CI 0.72-2.35) or ICU care (A1c 7-<9% OR 1.30, 95% CI 0.88-1.93;A1c ≥9% OR 1.35, CI 0.86-2.1 compared with A1c <7%;glucose >200 OR 1.26, CI 0.9-1.78). Age (per year OR 1.06, CI 1.04-1.08), male sex (OR 1.78, CI 1.14-2.81), obesity (OR 1.85, CI 1.16-2.96) and CKD (OR 1.90, CI 1.19-3.03) were significantly associated with mortality. Only female sex (OR 0.67, CI 0.48-0.93) was significantly associated with ICU care. In our retrospective study of hospitalized patients with DM, neither A1c nor admission glucose were prognostic of COVID-19 mortality or ICU care. In those with DM, male sex, obesity and CKD predicted worse outcomes.