ABSTRACT
SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Ethnic and racial disparities have been found to be influential drivers for poor outcomes in COVID-19 patients. Hispanic ethnic group has been recognized to have disproportionately higher COVID-19 infections and associated hospitalizations and deaths, which have been attributed to differences in socioeconomic and health factors, including high burden of comorbidities. However, studies specifically addressing the risk of death related to ethnicity alone are lacking. Therefore, we evaluated the association between Hispanic ethnicity and 30-day mortality in patients without comorbidities hospitalized with a COVID-19 diagnosis. METHODS: We included hospitalized patients with a COVID-19 diagnosis (based on the ICD-10 code U07.1) in an observational cohort study at the South Texas Veterans Health Care System (STVHCS) from April 1st, 2020 until December 31st, 2021. Additionally, we selected patients with no comorbidity burden based on a Charlson Comorbidity Index (excluding age) equal to zero. The index date was considered at the first documentation of COVID-19 diagnosis. We compared two independent groups: Hispanic vs. non-Hispanics. Our outcome of interest was 30-day all-cause mortality. Continuous variables were expressed as medians with interquartile ranges (IQR) and categorical variables were reported as absolute frequencies and percentages. A priori multivariable analysis was set to adjust for age, gender, and the probability of death at 30-days according to the validated Veterans Health Administration COVID-19 Index (VACO score). RESULTS: We identified 219 hospitalized COVID-19 patients with no comorbidities, stratified into Hispanics (n=87 [39.7%]) and non-Hispanics (n=132 [60.3%]). Demographic characteristics for Hispanics and non-Hispanics were comparable for median (IQR) age (48 [39-58] years vs. 51 [40-61] years), while there was a greater proportion of male gender in the Hispanic group (n=80 [92.0%] vs. n=110 [83.3%]). Hispanics had a lower probability of death according to the VACO score compared to non-Hispanics (0.22% [0.22%-2.95%] vs. 1.97% (0.22%-4.96%). Both groups had similar 30-day all-cause mortality, n=4 (4.6%) for Hispanics and n=4 (3.0%) for non-Hispanics with p-value=0.72. Due to the low number of deaths between the two groups, we were unable to perform a multivariate analysis. CONCLUSIONS: In this cohort of hospitalized COVID-19 patients without comorbidities, Hispanic ethnicity was not associated with an increased 30-day all-cause mortality. CLINICAL IMPLICATIONS: Our study demonstrates Hispanic ethnicity alone does not account for differences in outcomes of COVID-19 patients. Other factors, such as social determinants of health and comorbidity burden, have been shown to play significant roles and should be the focus of efforts to mitigate morbidity and mortality in COVID-19. DISCLOSURES: No relevant relationships by Liwayway Andrade No relevant relationships by Nicholas Hodgeman No relevant relationships by Michael Mader No relevant relationships by Marcos Restrepo No relevant relationships by Sandra Sanchez-Reilly
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SESSION TITLE: COVID-19: Other Considerations in Management SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: In the context of COVID-19, dementia is a well-established risk factor for COVID-19 mortality compared to patients without dementia. To the date, however, there is limited understanding on how a preexisting dementia diagnosis may impact time to death following COVID-19 infection. Of note, identification of risk factors for earlier versus later mortality has the potential to influence treatment and hospice care decisions. Therefore, our aim was to investigate if Veterans with preexisting dementia experienced a longer time from COVID-19 diagnosis to death (all-cause mortality) compared to those without dementia who died of COVID-19. METHODS: We conducted a retrospective, cross-sectional chart review study utilizing data collected at the South Texas Veteran Health Care System from April 2020 to December 2021. Participants comprised deceased Veterans from all-cause mortality following COVID-19 infection, both with and without a preexisting dementia diagnosis in the 5 years prior to COVID-19 diagnosis. We conducted a univariate analysis of covariance, controlling for patient age, to investigate if days from COVID-19 diagnosis to death differed between patients with and without a preexisting dementia diagnosis. RESULTS: A total of N= 382 deceased subjects from all-cause mortality infected with COVID-19 were found in our data base, with a mean age of 73.74 years (SD = 12.33). The majority (64.65%;n = 247) did not have dementia, while 35 % (n = 135) had a preexisting dementia diagnosis in their medical record. Results indicated that number of days from COVID-19 diagnosis to death did not differ (F(1, 379) = 0.02, p = ns) between deceased subjects with dementia (M = 74.6 days, SD = 81.0) and without dementia (M = 75.6, SD = 93.6), controlling for patient age. Patient age was nonsignificant in the model (F(1,379) = 0.44, p = ns). CONCLUSIONS: Among patients deceased for all-cause mortality with COVID-19 infection, results did not indicate a significant difference in time to death following COVID-19 diagnosis between patients with preexisting dementia or without, controlling for age. Although dementia is an established risk factor for COVID-19 related death, it is likely one piece of a complex puzzle in terms of predicting earlier versus later mortality. Future research is needed to identify potential moderators of illness trajectory prior to death among patients following a COVID-19 diagnosis. CLINICAL IMPLICATIONS: Further studies are needed on this field. Limitations of our study were abscense of subgroups for different severity dementia classification, the diagnosis of COVD-19 for our data base was made based on the day an ICD code was entered on the subject’s chart, rather than physician diagnosis, patient’s symptoms starting day, or previous outside COVID-19 tests. Moreover, we didn’t account for other comorbidities, and most patients were male. DISCLOSURES: No relevant relationships by Lisa Kilpela No relevant relationships by Michael Mader No relevant relationships by Onachi Ofoma No relevant relationships by Carlos Perez Ruiz No relevant relationships by Marcos Restrepo No relevant relationships by Sandra Sanchez-Reilly
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SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Asthma can be exacerbated by various triggers, including infections. One of the most frequent causes of exacerbations is respiratory viral infections. Therefore, asthmatics were expected to have worse outcomes during the COVID-19 pandemic. While mortality has often been measured in the first 30 days of diagnosis, there is paucity of data regarding the impact of pre-existing asthma in the long-term mortality after a hospitalization for COVID19. We investigated the association between pre-existing asthma and long-term all-cause mortality rate among hospitalized COVID-19 patients. METHODS: This is a retrospective cohort study from the South Texas Veterans Health Care System between April 1, 2020 and December 31, 2020 that included adults hospitalized with COVID-19. The cohort was stratified into two groups: pre-existing asthma vs. non-asthmatics patients. The patients were followed up to 365 post-index date of the COVID-19 diagnosis. The primary outcome was all-cause mortality within 365 days. Continuous variables were expressed as medians with interquartile ranges (IR) and categorical variables were reported as absolute frequencies and percentages. Multivariable analysis, including the Charlson Comorbidity Index was used to adjust for the comorbidity burden excluding asthma. RESULTS: We included 604 patients that required admission with a diagnosis of COVID-19. Pre-existing asthma occurred in 11% (n=66) of hospitalized patients with COVID-19. Asthmatic patients were younger with a median age of 64 years old (IQR 52-71) and less likely to be men (79%) compared to non-asthmatics with a median age of 68 (IQR 54-74) and 94% men, respectively. The Charlson Comorbidity Index was similar between asthmatics (median score of 3 [IQR of 2-7]) and non-asthmatic (median score of 3 [IQR 1-6]) COVID-19 hospitalized patients. The mortality rate within 365 days was numerically lower among asthmatics was 13.6% (n=9/66) when compared to non-asthmatics 21.6% (n=116/538) (p=0.13). Five of the 9 asthmatic patients died within the first 30 days post-COVID-19 diagnosis. In the multivariate analysis adjusted by Charlson Comorbidity Index, asthmatics had no statistically significant difference in mortality when compared to non-asthmatics COVID-19 patients (aOR=1.80;95%IC 0.84-3.87;p=0.13). CONCLUSIONS: There was no association between pre-existing asthma and all-cause mortality rate measured within 365 days after diagnosis of COVID-19 in hospitalized patients. CLINICAL IMPLICATIONS: Further assessment of asthma disease severity and specific therapies may assist clinicians on the potential protective effect seen in COVID-19 patients. DISCLOSURES: No relevant relationships by FRANKLIN ARGUETA No relevant relationships by Michael Mader Consultant relationship with GSK Please note: $5001 - $20000 by Diego Maselli Caceres, value=Consulting fee Consultant relationship with AstraZeneca Please note: $5001 - $20000 by Diego Maselli Caceres, value=Consulting fee Consultant relationship with Sanofi/Regeneron Please note: $5001 - $20000 by Diego Maselli Caceres, value=Consulting fee Speaker/Speaker's Bureau relationship with GSK Please note: 1 year by Diego Maselli Caceres, value=Consulting fee Speaker/Speaker's Bureau relationship with AstraZeneca Please note: 1 year by Diego Maselli Caceres, value=Honoraria Speaker/Speaker's Bureau relationship with Sanofi/Regeneron Please note: 1 year by Diego Maselli Caceres, value=Honoraria Consultant relationship with Amgen Please note: 10/1/2021 Added 04/04/2022 by Diego Maselli Caceres, value=Consulting fee No relevant relationships by Marcos Restrepo No relevant relationships by Sandra Sanchez-Reilly No relevant relationships by Kara Zabelny
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SESSION TITLE: Medications and Pulmonary Rehabilitation in COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Millions of people have survived COVID 19 infection and are living with post-acute sequelae of COVID (PASC). Multi-disciplinary programs have been established to provide follow-up to these patients. Currently, there are limited data regarding the effectiveness of these programs and it is uncertain if there is a mortality benefit. Here, we explore if the enrollment of Veterans into a multi-disciplinary COVID-19 follow-up program influences long term all-cause mortality. METHODS: We designed a retrospective cohort study at the South Texas Veteran Health Care system (STVHCS) from April 1, 2020, to December 31, 2020. Participants in the study were Veterans who survived a COVID 19 infection after 30 days and were eligible for enrollment in the STVHCS Convalescence Program (“The Program”), which conducts multi-disciplinary follow up care. Patients who died <30 days after COVID 19 diagnosis were not eligible. The primary outcome of long term all-cause mortality was defined as mortality within 31-365 days after the diagnosis of a COVID 19 infection. Demographic differences and primary outcome between the two groups (enrolled versus non-enrolled in The Program) were analyzed using Chi square for categorical variables. Continuous variables were analyzed using Student’s t-test. RESULTS: In total 2253 patients were eligible for enrollment, of which 557 were enrolled and 1696 were not enrolled. Long term all-cause mortality between the groups was 6/557 (1.07%) in the enrolled group compared to 78/1696 (4.59%) in the non-enrolled group with a p value of <0.001. There was no statistical difference between the groups based on the average Charlson comorbidity index score, 2.12 vs 2.09 respectively, with a p value = 0.85. CONCLUSIONS: Enrollment of Veterans in a COVID 19 multidisciplinary follow-up program is associated with a significant decrease in long term all-cause mortality. These differences could not be explained by inherent differences between groups. CLINICAL IMPLICATIONS: Our study shows the potential effectiveness of COVID-19 multidisciplinary follow-up programs to reduce long term all cause mortality in survivors of COVID. In addition there may be other benefits not yet explored such as reduction in symptom burden from COVID and decreased psychosocial distress. The generalizability of this study is limited by its observational study design, the voluntary nature of enrollment in the program and lack of non veterans in the population. DISCLOSURES: No relevant relationships by Ye Aung No relevant relationships by Ryan Choudhury No relevant relationships by Michael Mader No relevant relationships by Marcos Restrepo No relevant relationships by Sandra Sanchez-Reilly No relevant relationships by Monica Serra No relevant relationships by Ana Lucia Siu Chang No relevant relationships by Hanh Trinh