Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe.
J Intern Med
; 292(3): 438-449, 2022 09.
Article
in English
| MEDLINE | ID: covidwho-1774862
ABSTRACT
BACKGROUND:
Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe.OBJECTIVES:
The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic.METHODS:
A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe n = 1573; Northern Europe n = 821; Southern Europe n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aORs) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (gross domestic product, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day mortality was a secondary outcome.RESULTS:
The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%) and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95% confidence interval [CI] 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78).CONCLUSION:
This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Terminal Care
/
COVID-19
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Limits:
Aged
/
Humans
Country/Region as subject:
Europa
Language:
English
Journal:
J Intern Med
Journal subject:
Internal Medicine
Year:
2022
Document Type:
Article
Affiliation country:
Joim.13492
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