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Death among patients hospitalized with symptomatic COVID‐19: Implications for high‐risk patients
Author(s) -
Stefan Mihaela S.,
Eltanbedawi Ahmed,
Devoe Neil C.,
Khan Sabiha,
Zhou Ya,
Latef Taroob,
Esposito Anthony,
Fatima Anum,
Knee Alexander B.,
Lagu Tara C.
Publication year - 2022
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.12805
Subject(s) - medicine , interquartile range , death certificate , cause of death , covid-19 , palliative care , pediatrics , emergency medicine , intensive care medicine , disease , infectious disease (medical specialty) , nursing
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.