Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

Introduction Survivors of acute respiratory failure (ARF) commonly experience long-lasting physical, cognitive, and/or mental health impairments. Unmet medication needs occurring immediately after hospital discharge may have an important effect on subsequent recovery. Methods and analysis In this multicenter prospective cohort study, we enrolled ARF survivors who were discharged directly home from their acute care hospitalization. The primary exposure was unmet medication needs. The primary outcome was hospital readmission or death within 3 months after discharge. We performed a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the exposure–outcome association, with an a priori sample size of 200 ARF survivors. Results We enrolled 200 ARF survivors, of whom 107 (53%) were female and 77 (39%) were people of color. Median (IQR) age was 55 (43–66) years, APACHE II score 20 (15–26) points, and hospital length of stay 14 (9–21) days. Of the 200 participants, 195 (98%) were in the analytic cohort. One hundred fourteen (57%) patients had at least one unmet medication need;the proportion of medication needs that were unmet was 6% (0–15%). Fifty-six (29%) patients were readmitted or died by 3 months;10 (5%) died within 3 months. Unmet needs were not associated (risk ratio 1.25;95% CI 0.75–2.1) with hospital readmission or death, although a higher proportion of unmet needs may have been associated with increased hospital readmission (risk ratio 1.7;95% CI 0.96–3.1) and decreased mortality (risk ratio 0.13;95% CI 0.02–0.99). Discussion Unmet medication needs are common among survivors of acute respiratory failure shortly after discharge home. The association of unmet medication needs with 3-month readmission and mortality is complex and requires additional investigation to inform clinical trials of interventions to reduce unmet medication needs. Study registration number: NCT03738774. The study was prospectively registered before enrollment of the first patient. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03848-3.

COVID-19 Vaccine Effectiveness by Product and Timing in New York State (preprint)

BackgroundUS population-based data on COVID-19 vaccine effectiveness (VE) for the 3 currently FDA-authorized products is limited. Whether declines in VE are due to waning immunity, the Delta variant, or other causes, is debated. MethodsWe conducted a prospective study of 8,834,604 New York adults, comparing vaccine cohorts defined by product, age, and month of full-vaccination to age-specific unvaccinated cohorts, by linking statewide testing, hospital, and vaccine registry databases. VE was estimated from May 1, 2021 for incident laboratory-confirmed COVID-19 cases (weekly life-table hazard rates through September 3) and hospitalizations (monthly incidence rates through August 31). Results155,092 COVID-19 cases and 14,862 hospitalizations occurred. Estimated VE for cases declined contemporaneously across age, products, and time-cohorts, from high levels beginning May 1 (1.8% Delta variant prevalence), to a nadir around July 10 (85.3% Delta), with limited changes thereafter (>95% Delta). Decreases were greatest for Pfizer-BioNTech (-24.6%, -19.1%, -14.1% for 18-49, 50-64 years, and [≥]65 years, respectively), and similar for Moderna (-18.0%, -11.6%, -9.0%, respectively) and Janssen (-19.2%, -10.8, -10.9%, respectively). VE for hospitalization for adults 18-64 years was >86% across cohorts, without time trend. Among persons [≥]65 years, VE declined from May to August for Pfizer-BioNTech (95.0% to 89.2%) and Moderna (97.2% to 94.1%). VE was lower for Janssen, without trend, ranging 85.5%-82.8%. ConclusionsDeclines in VE for cases may have been primarily driven by factors other than waning. VE for hospitalizations remained high, with modest declines limited to Pfizer-BioNTech and Moderna recipients [≥]65 years, supporting targeted booster dosing recommendations.

Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York (preprint)

Importance: New York State (NYS) is an epicenter of the United States' COVID-19 epidemic. Reliable estimates of cumulative incidence of SARS-CoV-2 infection in the population are critical to tracking the extent of transmission and informing policies, but US data are lacking, in part because societal closure complicates study conduct. Objective: To estimate the cumulative incidence of SARS-CoV-2 infection and percent of infections diagnosed in New York State, overall and by region, age, sex, and race and ethnicity. Design: Statewide cross-sectional seroprevalence study, conducted April 19-28, 2020. Setting: Grocery stores (n=99) located in 26 counties throughout NYS, which were essential businesses that remained open during a period of societal closure and attract a heterogenous clientele. Participants: Convenience sample of patrons >=18 years and residing in New York State, recruited consecutively upon entering stores and via an in-store flyer. Exposures: Region (New York City, Westchester/Rockland, Long Island, Rest of New York State), age, sex, race and ethnicity. Main Outcomes: Primary outcome: cumulative incidence of SARS-CoV-2 infection, based on dry-blood spot (DBS) SARS-CoV-2 antibody reactivity; secondary outcome: percent of infections diagnosed. Results: Among 15,101 adults with suitable DBS specimens, 1,887 (12.5%) were reactive using a validated SARS-CoV-2 IgG microsphere immunoassay (sensitivity 87.9%, specificity 99.75%). Following post-stratification weighting on region, sex, age, and race and ethnicity and adjustment for assay characteristics, estimated cumulative incidence through March 29 was 14.0% (95% CI: 13.3-14.7%), corresponding to 2,139,300 (95% CI: 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was higher among Hispanic/Latino (29.2%, 95% CI: 27.2-31.2%), non-Hispanic black/African American (20.2% 95% CI, 18.1-22.3%), and non-Hispanic Asian (12.4%, 95% CI: 9.4-15.4%) adults than non-Hispanic white adults (8.1%, 95% CI: 7.4-8.7%, p