Death among patients hospitalized with symptomatic COVID‐19: Implications for high‐risk patients

Abstract

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 endof-life discussions and implement shared decision-making in high-risk patients early on or prior to hospitalization. BACKGROUNDAs of October 2021, more than 660,000 people in the United States have died from complications related to COVID-19. 1 In one metaanalysis, global mortality for hospitalized patients was estimated at 17% in patients not admitted to the intensive care unit and 40% in studies of critically ill patients. 2 Factors associated with mortality include older age, chronic medical conditions (e.g., diabetes mellitus, chronic lung diseases, obesity or hypertension), 3 and frailty. 4 Although it is likely that many patients who die with COVID-19 were low-risk prior to contracting the illness, the number that come from lower risk groups is unknown. In fact, some lay outlets and even scientific papers have argued that almost no low-risk patients die of COVID. 5,6

Estimates of Population-level Palliative Care Needs in the UK: Pre-Pandemic and During the Pandemic

“…In contrast, the increase in deaths during the pandemic was re ected in the intermediate estimates, with these estimates showing more people in need of palliative care during the pandemic years than prepandemic. Even though COVID-19 was not included as a cause of death requiring palliative care in these estimates, the increase in need was due to a high proportion of the people who died with COVID-19 also having chronic health conditions that would bene t from palliative care (25,26,35). The intermediate estimates' exibility to account for underlying or contributory causes of death makes them more robust estimates of need than the minimal estimates.…”

“…In these, the minimal estimates increased substantially (~ 10%), and the intermediate estimates increased slightly (~ 2%). The differing impacts on the minimal and intermediate estimates are because the conventional intermediate estimates, which account for contributory causes of death, already capture many COVID-19 deaths due to the high rates of comorbidities in people who die with COVID-19 (35).…”

Risk Factors Associated with Severity and Death from COVID-19 in Iran: A Systematic Review and Meta-Analysis Study

“… 17 Although social and public interventions in countries reduce the adverse effects of COVID-19, recognizing the risk factors associated with COVID-19 severity and death in communities can help the health system identify high-risk groups and implement appropriate risk-reduction interventions. 18 , 19 In Iran, several social and non-pharmacological interventions have been performed to reduce the COVID-19 adverse effects, but recognizing the factors associated with the incidence of death and severity can provide comprehensive information on high-risk and low-risk groups. To our knowledge, separate studies have shown the relationship between some factors, but systematically, related risk factors have not been studied.…”

Improving goal‐concordant care in the hospital for patients with dementia in the COVID‐19 era

“…In April 2022 issue, Stefan et al present findings from a retrospective cohort study examining patient characteristics of adults over age 50 with COVID-19 infection who died while hospitalized. 2 While some patients died unexpectedly due to COVID-19, approximately 60% had a serious or advanced illness with a potential prognosis of less than 12 months in the absence of COVID-19 infection. Among the patients in this study, over 40% had a diagnosis of dementia, and almost half (47%) were admitted from skilled nursing or long-term care facility.…”