COVID-19 patients followed in Portuguese Primary Care: a retrospective cohort study based on the national case series

Abstract

Background The pandemic state caused by SARS-CoV-2 came to overburden all levels of healthcare, including Primary Care. In Portugal, most patients were followed in ambulatory, monitored by phone calls or face-to-face visits by their General Practitioner. Objective The aim was to characterize the pathway of COVID-19 outpatients in Primary Care and establish the risk factors that mostly influence the need for hospitalization or death during the follow-up. Methods A retrospective cohort study was established, based on the official Portuguese dataset of first wave between March 2nd and July 31st, 2020. The predictive effects of variables, including age, gender, residency and clinical features, were analyzed using Cox regression analysis. Results A total of 38,545 patients infected with SARS-CoV-2 were included for analysis (56.3% females), with a median age of 47 years old. There were 4,327 hospitalized patients, 253 in intensive care units and 1,153 deaths. Females present low risk of hospitalization (HR=0.777; 95% CI: 0.734-0.823; p<0.001) and age is associated to higher risk (HR=7.076; 95% CI: 6.679-7.496; p<0.001), as the presence of at least one comorbidity (HR=7.033; 95% CI: 6.434-7.687; p<0.001). Multivariate analysis showed that cardiovascular disease, diabetes, smoking, obesity, chronic kidney disease, cancer, chronic obstructive pulmonary disease, HIV and other immunodeficiencies, transplant or immunosuppression, hematologic disorders, neurological disorders and liver disease increased the risk of hospitalization. Conclusion Male gender, elders and the presence of comorbidities are the main determinants for hospitalization and death. These COVID-19 patients should receive a higher attention when they come to primary care for assistance.