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EClinicalMedicine
. 2021 Jun 9;100941.
doi: 10.1016/j.eclinm.2021.100941. Online ahead of print.
A simple, home-therapy algorithm to prevent hospitalisation for COVID-19 patients: A retrospective observational matched-cohort study
Fredy Suter 1 , Elena Consolaro 2 , Stefania Pedroni 2 , Chiara Moroni 2 , Elena Pastò 2 , Maria Vittoria Paganini 2 , Grazia Pravettoni 3 , Umberto Cantarelli 4 , Nadia Rubis 5 , Norberto Perico 5 , Annalisa Perna 5 , Tobia Peracchi 5 , Piero Ruggenenti 1 5 , Giuseppe Remuzzi 5
Affiliations
- PMID: 34127959
- PMCID: PMC8189543
- DOI: 10.1016/j.eclinm.2021.100941
Abstract
Background: Effective home treatment algorithms implemented based on a pathophysiologic and pharmacologic rationale to accelerate recovery and prevent hospitalisation of patients with early coronavirus disease 2019 (COVID-19) would have major implications for patients and health system.
Methods: This academic, matched-cohort study compared outcomes of 90 consecutive consenting patients with mild COVID-19 treated at home by their family physicians between October 2020 and January 2021 in Northern and Central Italy, according to the proposed recommendation algorithm, with outcomes for 90 age-, sex-, and comorbidities-matched patients who received other therapeutic regimens. Primary outcome was time to resolution of major symptoms. Secondary outcomes included prevention of hospitalisation. Analyses were by intention-to-treat.
Findings: All patients achieved complete remission. The median [IQR] time to resolution of major symptoms was 18 [14-23] days in the 'recommended schedule' cohort and 14 [7-30] days in the matched 'control' cohort (p = 0·033). Other symptoms persisted in a lower percentage of patients in the 'recommended' than in the 'control' cohort (23·3% versus 73·3%, respectively, p<0·0001) and for a shorter period (p = 0·0107). Two patients in the 'recommended' cohort were hospitalised compared to 13 (14·4%) controls (p = 0·0103). The prevention algorithm reduced the days and cumulative costs of hospitalisation by >90%.
Interpretation: Implementation of an early home treatment algorithm failed to accelerate recovery from major symptoms of COVID-19, but reduced the risk of hospitalisation and related treatment costs. Given the study design, additional research would be required to consolidate the proposed treatment recommendations.
Funding: Fondazione Cav.Lav. Carlo Pesenti.
Keywords: COVID-19; Early symptoms at home; Family physicians; Matched-cohort observational study; SARS-CoV-2; Simple home-therapy algorithm.