Palliative Care Utilization Among Patients With COVID-19 in an Underserved Population: A Single-Center Retrospective Study

Haydar, Ali; Lo, Kevin Bryan; Goyal, Abhinav; Gul, Fahad; Peterson, Eric; Bhargav, Ruchika; DeJoy, Robert; Salacup, Grace; Pelayo, Jerald; Albano, Jeri; Azmaiparashvili, Zurab; Ansari, Huma; Aponte, Gabriel Patarroyo

doi:10.1016/j.jpainsymman.2020.05.022

Cited by 26 publications

(22 citation statements)

References 11 publications

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“…A detailed overview of study characteristics is presented in the Supplementary data, Table S2 . Most studies (84 studies) reported data on COVID-19 patients from China [ 3 , 4 , 10 , 11 , 28–38 , 42–44 , 46–53 , 55 , 56 , 58–77 , 85 , 87 , 88 , 90 , 107–109 , 112 , 118–123 , 132–135 , 137–140 , 142 , 143 , 146–148 , 150–160 ], 27 studies were conducted in the USA [ 11 , 12 , 25 , 27 , 40 , 57 , 78 , 81 , 84 , 94 , 98–101 , 103 , 105 , 111 , 114 , 116 , 124 , 129–131 , 136 , 141 , 145 , 149 , 163 ], 23 studies reported data from Europe [ 26 , 39 , 45 , 54 , 80 , 82 , 83 , 86 , 89 , 91–93 , 95–97 , …”

Section: Resultsmentioning

confidence: 99%

Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis

Janse

Jong

et al. 2020

Clinical Kidney Journal

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Background Acute kidney injury (AKI) can affect hospitalized patients with coronavirus disease 2019 (COVID-19), with estimates ranging between 0.5% and 40%. We performed a systematic review and meta-analysis of studies reporting incidence, mortality and risk factors for AKI in hospitalized COVID-19 patients. Methods We systematically searched 11 electronic databases until 29 May 2020 for studies in English reporting original data on AKI and kidney replacement therapy (KRT) in hospitalized COVID-19 patients. Incidences of AKI and KRT and risk ratios for mortality associated with AKI were pooled using generalized linear mixed and random-effects models. Potential risk factors for AKI were assessed using meta-regression. Incidences were stratified by geographic location and disease severity. Results A total of 3042 articles were identified, of which 142 studies were included, with 49 048 hospitalized COVID-19 patients including 5152 AKI events. The risk of bias of included studies was generally low. The pooled incidence of AKI was 28.6% [95% confidence interval (CI) 19.8–39.5] among hospitalized COVID-19 patients from the USA and Europe (20 studies) and 5.5% (95% CI 4.1–7.4) among patients from China (62 studies), whereas the pooled incidence of KRT was 7.7% (95% CI 5.1–11.4; 18 studies) and 2.2% (95% CI 1.5–3.3; 52 studies), respectively. Among patients admitted to the intensive care unit, the incidence of KRT was 20.6% (95% CI 15.7–26.7; 38 studies). Meta-regression analyses showed that age, male sex, cardiovascular disease, diabetes mellitus, hypertension and chronic kidney disease were associated with the occurrence of AKI; in itself, AKI was associated with an increased risk of mortality, with a pooled risk ratio of 4.6 (95% CI 3.3–6.5). Conclusions AKI and KRT are common events in hospitalized COVID-19 patients, with estimates varying across geographic locations. Additional studies are needed to better understand the underlying mechanisms and optimal treatment of AKI in these patients.

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Section: Resultsmentioning

confidence: 99%

Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis

Janse

Jong

et al. 2020

Clinical Kidney Journal

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“…[3][4][5] Research to date, examining the role of palliative care during this pandemic has focused on strategies developed to implement novel palliative care models in the hospital setting. 6 This research has also highlighted the overall utilisation of palliative care services in patients admitted to the hospital with COVID-19, 7 along with proactive strategies applied in ICU settings to quickly identify patients with palliative care needs. 8 The objective of this study was to examine the utilisation rates of palliative care consultation in critically ill patients with COVID-19 pneumonia admitted to two ICUs in New York City.…”

Section: Introductionmentioning

confidence: 99%

Palliative care in critically ill COVID-19 patients: the early New York City experience

Sheehan

Poon

et al. 2020

BMJ Support Palliat Care

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ObjectivesThe COVID-19 pandemic in the USA has been accompanied by high rates of mortality and an unprecedented need for palliative care delivery. Little is known about the use of palliative care services in intensive care unit (ICU) settings during the COVID-19 pandemic.MethodsThis is a retrospective cohort study of critically ill COVID-19 patients requiring ICU admission, between 7 March and 14 April 2020 to two academic teaching hospitals in New York City. Palliative care consultation included a one-time telemedicine consultation or continued telemedicine consultation and follow-up with multidisciplinary team involvement. Patient information was collected from the electronic health record and analyses were conducted with Stata V.15.1 (StataCorp) statistical software.ResultsA total of 151 critically ill patients with COVID-19 pneumonia requiring ICU admission were identified, of whom 59 (39.07%) received an inpatient palliative care consultation. More than half of patients died (n=85/151, 56.29%), with 57.65% (n=49/85) of these patients receiving palliative care services during their hospitalisation. Patients who received palliative care consultation were more likely to be older, sicker and receive mechanical ventilation than their counterparts. Patients who died and did not receive palliative care were younger and required non-invasive ventilation support.ConclusionThere is a lack of utilisation of palliative care in COVID-19 patients admitted to the ICU. Further research into predictors of poor outcomes in critically ill COVID-19 patients may help identify patients that would benefit from early palliative care involvement going forward.

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“…10 11 Palliative medicine specialists can make a fundamental contribution precisely because of their ability and experience to work in an organised multiprofessional context and in clinical care environments where difficult choices and limited resources are on the daily teamwork agenda. [10][11][12] An important point to underline is the topic of clinical multidisciplinary work and shared decision making. The innovative element we reckon of interest is the organisation of a work process that allows this integration to be fulfilled on a case-by-case basis with a multidisciplinary approach.…”

Section: Discussionmentioning

confidence: 99%

“…Preparedness of the system to exceptional needs must build both on implementing core palliative care skills in the healthcare system, 14 addressing both the community level 15 16 and the acute care facilities. [10][11][12] It is necessary to think of a hospital where the organisational models are aimed at making possible and dignified any end-of-life path, regardless of the cause that determines it. This will make the difference between a hospital where we do everything possible and a hospital where we believe in a different possible.…”

Section: Short Reportmentioning

confidence: 99%

COVID-19 emergency and palliative medicine: an intervention model’

Riva¹,

Caraceni

Vigorita³

et al. 2020

BMJ Support Palliat Care

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ObjectivesThe aim of this work is to describe the multidisciplinary model of intervention applied and the characteristics of some COVID-19 patients assisted by the hospital palliative care unit (UCP-H) of an Italian hospital in Lombardy, the Italian region most affected by the COVID-19 pandemic.MethodsA retrospective study was conducted on patients admitted to the A. Manzoni Hospital (Lecco, Lombardy Region, Italy) and referred to the UCP-H between 11 March 2020 and 18 April 2020, the period of maximum spread of COVID-19 in this area. Data were collected on the type of hospitalisation, triage process, modality of palliative care and psychological support provided.Results146 COVID-10 patients were referred to the UCP-H. Of these, 120 died during the observation time (82%) while 15 (10.2%) improved and were discharged from the UCP-H care. 93 had less favourable characteristics (rapid deterioration of respiratory function, old age, multiple comorbidities) and an intensive clinical approach was considered contraindicated, while 48 patients had more favourable presentations. Mean follow-up was 4.8 days. A mean of 4.3 assessments per patient were performed. As to respiratory support, 94 patients were treated with oxygen only (at different volumes) and 45 with Continuous Positive Airway Pressure (CPAP).ConclusionThe ongoing pandemic highlighted the need for dedicated palliative care teams and units for dying patients. This work highlights how palliative medicine specialist can make a fundamental contribution thanks to their ability and work experience in an organised multiprofessional context.

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Palliative Care Utilization Among Patients With COVID-19 in an Underserved Population: A Single-Center Retrospective Study

Cited by 26 publications

References 11 publications

Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis

Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis

Palliative care in critically ill COVID-19 patients: the early New York City experience

COVID-19 emergency and palliative medicine: an intervention model’

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