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Outcomes for hospitalized patients with non-COVID conditions have not differed since the onset of the pandemic, compared with before the pandemic, data suggest.
In a retrospective study that examined almost 250,000 hospitalizations, patients with conditions such as heart failure and concomitant COVID-19 co-infection had a 4.7% higher rate of 30-day mortality, compared with patients with the studied conditions but without COVID-19. For hospitalized patients without COVID-19, mortality and length of stay remained stable after the onset of the pandemic.
“Our hypothesis was that we were going to find worse outcomes in patients without COVID who were hospitalized during the pandemic, because there have been studies showing that when COVID inpatient numbers surged, the outcomes for COVID patients got worse,” lead author Finlay McAlister, MD, professor of general internal medicine at the University of Alberta in Edmonton, Canada, told Medscape Medical News. “Despite our assumption that everybody’s outcomes would get worse, even if they did not have COVID-19, we did not find that. The length of stay and 30-day mortality was the same for most patients (except those with heart failure or COPD or asthma) if they did not have COVID co-infection.”
The study was published July 12 in JAMA Network Open.
Stability Through Surges
To examine whether inpatient COVID-19 caseloads were associated with outcomes in hospitalized patients without COVID-19, the investigators conducted a retrospective cohort study. They examined data from Alberta and Ontario for adults who were hospitalized before the pandemic (from April 2018 through September 2019) and those hospitalized during the pandemic (from April 2020 through September 2021). Eligible participants were hospitalized for heart failure, chronic obstructive pulmonary disease (COPD) or asthma, urinary tract infection or urosepsis, acute coronary syndrome, or stroke.
The investigators used the monthly surge index at each hospital as a measure of COVID-19 caseload in relation to baseline bed capacity. The primary outcome was 30-day all-cause mortality after hospital admission. The secondary outcome was length of stay.
The analysis included 132,240 patients hospitalized before the pandemic and 115,225 hospitalized during the pandemic. Patients admitted with any of the selected conditions (which are the five most common reasons for hospitalizations in Canada) in addition to COVID-19 infection had a mean 4.7% absolute increase in mortality at 30 days and stayed in the hospital a mean of 8.6 days longer, compared with patients without COVID-19.
Finlay noted that the researchers adjusted their analysis to address the differences in risk profile between patients admitted to the hospital during the pandemic and those admitted before the pandemic. For example, fewer people from nursing homes were admitted during the pandemic period examined in this study.
Patients hospitalized with urinary tract infection or urosepsis, acute coronary syndrome, or stroke, but without COVID-19 infection, had no differences in length of stay or 30-day mortality during the pandemic, compared with before. But patients hospitalized with heart failure and COPD or asthma had higher risk-adjusted 30-day mortality during the pandemic than before (16% higher for heart failure; 41% higher for COPD or asthma).
When COVID-19 inpatient numbers surged, length of stay and risk-adjusted mortality were significantly higher for patients with COVID-19 but stable for those with non–COVID-19 conditions, said McAlister.
One of the possible explanations that McAlister offered for these findings is that Canadian hospital staff were accustomed to managing at near-capacity even before the pandemic. The investigators noted that the average hospital occupancy rate was 92% in Canada in 2019, which was the highest rate of all Organisation for Economic Co-Operation and Development (OECD) countries. Moreover, Canada ranks 33rd of 36 OECD countries in the number of acute care beds per 1000 people.
“It definitely would be interesting to see if the results are the same in other countries that weren’t used to dealing with the same capacity challenges at baseline as we are in Canada,” said McAlister.
No Major Changes
Commenting on the study for Medscape, Kieran Quinn, MD, PhD, a general internist and clinician–scientist at Sinai Health System in Toronto, noted that the use of population data from two provinces rather than only one is a strength of the study.
“It’s closer to representing more of the Canadian experience, rather than the experience of any single province or territory,” explained Quinn. The two provinces analyzed account for about half of the Canadian population, he added. Quinn was not involved in the study.
Another strength of the study is its temporal comparison with respect to outcomes, noted Quinn. “The appealing piece is that they compared outcomes in the prepandemic periods with outcomes that occurred during the pandemic. They could have just described what happened to people with these health conditions during the pandemic, but that approach would not give us a comparator as a point of reference.”
Given that the results suggest that patients who did not have COVID-19 infection had similar outcomes before and during the pandemic, the data are encouraging, said Quinn.
“The main takeaway from this study is that, reassuringly, we did not see major changes [to] in-hospital related outcomes for most people in the two provinces, although we did see some potentially concerning signals that specific subgroups of people with specific conditions might have experienced worse outcomes during the pandemic, which bears further study,” said Quinn.
ICES, which is funded by the Canadian Institutes of Health Research COVID-19 Rapid Research Funding Opportunity grant VR4 172736 from the Ontario Ministry of Health and the Ministry of Long-Term Care, supported the Ontario portion of this study. McAlister and Quinn reported no relevant financial relationships.
JAMA Netw Open. Published July 12, 2023. Full text
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