ABSTRACT
Outcomes: 1. Compare characteristics and clinical outcomes of inpatients with COVID receiving palliative care consultation (PCC) versus those who did not. 2. Elucidate evolution of PCC interventions over trajectory of successive COVID surges. Background/objectives: Palliative care (PC) teams have played an integral role in the care of critically ill patients hospitalized with COVID-19. This study describes how an inpatient, hands-on palliative care team adapted as the viral characteristics of the disease evolved. Method(s): Retrospective chart review of 2,879 patients, hospitalized with a primary diagnosis of COVID-19, at a large, urban academic hospital in Washington, DC from March 2020 through March 2022. Data was collected on baseline demographics, clinical characteristics, hospital course, and palliative care consultations (PCCs). Results were compared between patients receiving PCCs and those who did not. Trends in results were studied across the region's three surge periods, "Initial" (March 2020 to June 2020), "Delta" (November 2020 to April 2021), and "Omicron" (December 2021 to January 2022). Result(s): In-hospital mortality declined over the Initial, Delta, and Omicron surges with mortality rates of 17.5% (n=137), 13.6% (n=121), and 11.2% (n=62), respectively. ICU admission rates declined, with 21.6% (n=169), 21.3% (n=189) and 17.0% (n=94) for each of the surges. 393 (13.7%) patients received a PCC, with consult rates of 12.7%, 12.1%, and 14.3% for each surge, respectively. In-hospital mortality for PCC patients was 47.8% (41.1%, 51.2%, 40.9% by surge) vs. 9.3% for non-PCC (14.2%, 7.3%, 5.6%). Majority of PCC patients had COPD in Initial (87.4%, n=83) and Delta (93.7%, n=119) surges (14.8%, n=13 for Omicron). As hospital staff became acclimated to the pandemic and the sense of urgency declined, the days to PCC increased (7.1, 8.8, 10.1 days, respectively). During the Initial surge, the primary PCC interventions were for symptom management (28.5%, n=290), psychosocial support (18.9%, n=193), and goals of care (14.9%, n=152). Psychosocial support (13.5%, n=172) and goals-of-care (6.3%, n=80) interventions declined during the less acute Omicron surge (13.5%, n=172), while symptom management increased (38.2%, n=488). Conclusion(s): The demographic profile and viral characteristics of COVID-19 patients changed over the course of the pandemic, impacting both patient outcomes and palliative care's interdisciplinary response to the needs of patients and families.Copyright © 2023
ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Studies have demonstrated the disproportionate impact of COVID-19 on patients from racial and ethnic minorities. Black and Hispanic people suffer disproportionately high rates of infection with SARS-CoV-2, hospitalization, and mortality, compared to non-Hispanic White people. However, case fatality rates have been shown to be similar across racial and ethnic groups. Less is known about the factors underpinning the similar case fatality rates between different racial and ethnic populations. METHODS: This retrospective cohort study analyzed outcomes for patients with COVID-19 hospitalized at MedStar Health institutions between March 1st, 2020 and July 1st, 2020. MedStar Health is a large health system with 9 hospitals in the Baltimore-Washington DC region. Data was abstracted from electronic health records, with patients stratified based on their race and ethnicity. The primary outcome was survival to hospital discharge, and secondary outcomes included need for mechanical ventilation. Statistical analyses included descriptive statistics and multi-variate logistic regressions. RESULTS: 3,165 patients were included in this analysis. The mean age of the cohort was 60.2 years (SD 17.3) and 49% were female. 14.7% were non-Hispanic White patients, 57.2% were non-Hispanic Black patients, and 20.7% were Hispanic. Hispanic patients were significantly younger than the cohort, with a mean age of 50.0 years. The overall survival of this cohort was 84.3%, with 79.8% survival for non-Hispanic White patients, 83.3% for non-Hispanic Black patients, and 89.8% for Hispanic patients. Hispanic patients had lower odds of death than non-Hispanic White patients (OR=0.45, CI 0.32-0.63), but this difference was no longer present when controlling for patient age. Non-Hispanic Black patients (OR=1.35, CI 1.04-1.75) and Hispanic patients (OR=1.43, CI 1.06-1.93) had significantly increased odds of needing mechanical ventilation, with persistence of this difference when controlling for age, gender, insurance, and comorbidities. CONCLUSIONS: In this large cohort of patients from the Baltimore-Washington DC region hospitalized for SARS-CoV-2 infection, we demonstrate that patients of Hispanic ethnicity have higher odds of severe illness, as defined by need for mechanical ventilation, but lower hospital mortality than non-Hispanic White patients. The lower hospital mortality rate is likely mediated by the younger age of this group. CLINICAL IMPLICATIONS: Policy makers should consider interventions to target the social determinants such as differences in access to health care and risk of exposure to COVID-19 that may account for the higher odds of severe infection and delayed presentation among Hispanic patients. Additionally, our findings suggest that Hispanic community may be shouldering a disproportionate burden of chronic illness related to surviving severe COVID-19. DISCLOSURES: No relevant relationships by Muhtadi Alnababteh, source=Web Response No relevant relationships by Victor Avila-Quintero, source=Web Response No relevant relationships by Jose Flores, source=Web Response No relevant relationships by Hunter Groninger, source=Web Response No relevant relationships by Nina Laing, source=Web Response No relevant relationships by Anirudh RAO, source=Web Response No relevant relationships by Akram Zaaqoq, source=Web Response