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Death among patients hospitalized with symptomatic COVID-19: Implications for high-risk patients
Mihaela S Stefan1,2, Ahmed Eltanbedawi2,3, Neil C Devoe2,3
1Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA.
Insights
For 40% of patients who died from COVID-19 complications, death was unexpected. For others, improved end-of-life discussions are needed to enhance shared decision-making in high-risk patients.
Area of Science:
- Gerontology
- Infectious Diseases
- Critical Care Medicine
Background:
- Investigating the impact of COVID-19 on patient mortality.
- Determining the extent to which COVID-19 contributed to deaths.
Purpose of the Study:
- To analyze the role of COVID-19 infection in patient mortality.
- To ascertain the proportion of deaths where COVID-19 was a major contributing factor.
Main Methods:
- Study included hospitalized patients aged 50 and above who died from COVID-19 between March and September 2020.
- Defined COVID-19 as a major cause of death if it was improbable to die without the infection in patients with well-controlled conditions.
- Defined COVID-19 as a minor cause if serious illnesses and palliative care indications were present.
Main Results:
- The study analyzed 243 patients with a median age of 80; 40% were female.
- Nearly 60% had serious pre-existing illnesses, with expected death within 12 months.
- In 40% of cases, deaths were unexpected, indicating COVID-19 complications as the primary cause.
Conclusions:
- For 40% of patients, death from COVID-19 complications was unexpected.
- Opportunities exist to enhance end-of-life discussions and shared decision-making for high-risk patients prior to hospitalization.
Background:
We aimed to examine the role played by the COVID-19 infection in patients' death and to determine the proportion of patients for whom it was a major contributor to death.
Methods:
We included patients ≥50 years old who were hospitalized with COVID-19 infection and died between March 1, 2020 and September 30, 2020 in a tertiary medical center. We considered COVID-19 infection to be a major cause for death if the patient had well-controlled medical conditions and death was improbable without coronavirus infection, and a minor cause for death if the patient had serious illnesses and had an indication for palliative care.
Results:
Among 243 patients, median age was 80 (interquartile intervals: 72-86) and 40% were female. One in two had moderate or severe frailty and 41% had dementia. Nearly 60% of the patients were classified as having advanced, serious illnesses present prior to the hospitalization, with death being expected within 12 months, and among this group 39% were full code at admission. In the remaining 40% of patients, deaths were classified as unexpected based on patients' prior conditions, suggesting that COVID-19 infection complications were the primary contributor to death.
Conclusions:
For slightly less than half (40%) of patients who died of complications of COVID-19, death was an unexpected event. Among the 60% of patients for whom death was not a surprise, our findings identify opportunities to improve end-of-life discussions and implement shared decision-making in high-risk patients early on or prior to hospitalization.
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