The study, entitled Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic, sought to answer the following question: What factors were associated with observed trends in the in-hospital mortality rates in the United States during the first 9 months of the COVID-19 pandemic?

In-hospital mortality rates from COVID-19 were high but appeared to be decreasing for selected locations in the United States during 2020. The authors sought to identify the following;

• If changes in the characteristics of patients being admitted could account for the decreases
• If changes in treatment protocols could account for the reduction in deaths

According to the authors, they arrived at the following conclusion;

In this cohort study of 20 736 patients, in-hospital mortality rates decreased in the US between March and November 2020, even after accounting for the changing mix in patient age, sex, comorbidities, and disease severity at the time of admission. Hospital and intensive care unit length of stay and use of mechanical ventilation decreased over time, whereas the use of glucocorticoids and remdesivir increased.

In March and April, the overall in-hospital mortality rate was 19.1 percent. This figure fell to 11.9 percent in May and June, before tapering off at 10.8 percent from September through November.

While there were small changes in the patient population over the study period — including a slight decrease in age and a higher proportion of women — mortality rates decreased even after researchers adjusted for factors including age, sex, comorbidities, and COVID-19 disease severity.

According to lead author Gregory Roth, an associate professor of medicine at the University of Washington’s Institute for Health Metrics and Evaluation in Seattle,

“Our findings suggest that the decline in mortality could be due to overloaded hospitals and changes in treatment, Further analysis is needed to understand the drivers more precisely, but it speaks to a crucial need for information-sharing and identifying hospital best practices that can prevent mortality rates from increasing again, particularly during possible future waves of COVID-19 infections.”

The study identified various obstacles in its collection of data. Surveillance proved particularly challenging. In the United States, where no single registry tracks all COVID-19 cases. The American Heart Association’s (AHA) COVID-19 Cardiovascular Disease (CVD) Registry powered by Get With The Guidelines was deployed in April 2020 to address this gap and as a means of tracking hospital-based outcomes and improving national surveillance of all patients with COVID-19 admitted to a hospital

Study Cohort and Patient Characteristics

Their analysis included 20 736 patients admitted between March and November 2020 at 107 hospitals in 31 states, with 11 901 patients admitted in March or April, 4116 patients in May or June 2709 in July or August, and 2010 patients in September through November.

The mean (SD) age was 61.2 (17.9) years, and 9524 (45.9%) were women. Hypertension was the most common preexisting condition recorded, present in more than half of patients, followed by diabetes in just over a third of patients. Pulmonary disease (including chronic obstructive pulmonary disease) was present in almost one-fifth of patients. Cancer was present in 2560 patients (12.3%), chronic kidney disease in 2628 patients (12.7%), and heart failure in 2343 patients (11.3%).

At the time of admission to the hospital, the mean (SD) BMI was in the obese range (ie, 30.8 [8.5]), and approximately a quarter of patients were receiving supplemental oxygen.

To view the full study, click here.

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