Author: Ty J. Gluckman, M.D., medical director, Providence Center for Cardiovascular Analytics Research and Data Science (CARDS), Providence Heart Institute
A new study co-authored at Providence found that patients hospitalized for urgent conditions unrelated to COVID-19 died at a higher rate during two COVID-19 surges in 2020, likely from patients unnecessarily delaying their care. The study was published in the Journal of Hospital Medicine. (Authors: Amber K. Sabbatini, M.D., MPH, Ari Robicsek, M.D., Shih-Ting Chiu, Ph.D., Ty J. Gluckman, M.D.)
Our study sought to evaluate the extent to which the COVID-19 pandemic affected outcomes in those with unplanned hospitalizations. Included in the analysis were patients hospitalized between Jan. 1, 2019 (prior to COVID-19) and Dec. 31, 2020, at one of 51 Providence hospitals in six states.
Concurrent with a decline in unplanned hospitalizations during spring and fall COVID-19 surges, the average in-hospital mortality rate rose from 2.9% to 3.5%, amounting to about 5 to 6 excess deaths per 1,000 hospitalizations.
Unplanned hospitalizations declined steeply during the spring and fall COVID-19 surges of 2020 (down by 48% and 25%, respectively). During these same periods, an approximate 20% relative increase in hospital mortality was observed. A relatively consistent pattern was noted for a wide variety of medical conditions (e.g., heart failure, pneumonia, acute renal failure, GI hemorrhage, hip fracture).
While the exact drivers for the observed findings are not known, there is concern that many patients may have delayed their care out of fear of contracting COVID-19. Other potential explanations include a change in the case mix of those who were hospitalized, barriers to timely pre-hospital and in-hospital care, and a change in the quality of care delivered.
The study included nearly 800,000 hospitalizations in Alaska, Washington, Montana, Oregon, California and Texas. The spring COVID-19 surge extended from March 4, 2020, to May 13, 2020, coinciding with shelter-in-place mandates. The fall surge extended from Oct. 20, 2020, to Dec. 31, 2020. While in-hospital mortality rates returned back to baseline in between the COVID-19 surges, hospitalization rates did not.
As we continue to deal with current and future pandemics, it is imperative that we unambiguously communicate to patients that our clinics and hospitals are safe places to receive care, regardless of what they need. With case counts related to the delta variant continuing to rise, this message is more important than ever.
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