TY - JOUR
T1 - Association of COVID-19 Hospitalization Volume and Case Growth at US Hospitals with Patient Outcomes
AU - Khera, Rohan
AU - Liu, Yusi
AU - de Lemos, James A.
AU - Das, Sandeep R.
AU - Pandey, Ambarish
AU - Omar, Wally
AU - Kumbhani, Dharam J.
AU - Girotra, Saket
AU - Yeh, Robert W.
AU - Rutan, Christine
AU - Walchok, Jason
AU - Lin, Zhenqiu
AU - Bradley, Steven M.
AU - Velazquez, Eric J.
AU - Churchwell, Keith B.
AU - Nallamothu, Brahmajee K.
AU - Krumholz, Harlan M.
AU - Curtis, Jeptha P.
N1 - Funding Information:
Funding: RK received support from the National Heart, Lung, and Blood Institute of the National Institutes of Health under the grant 1K23HL153775 . The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Funding Information:
Conflict of Interest: JAdL reports fees for participating in Data Monitoring Committees from Eli Lilly and Novo Nordisc and consulting income from Jannsen. DJK reports serving on the writing committee of the 2018 American Association for Thoracic Surgery/American College of Cardiology/Society for Cardiovascular Angiography and Interventions/Society of Thoracic Surgeons Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement. WRY reports grants and personal fees from Abbott Vascular, AstraZeneca, Medtronic, and Boston Scientific outside the submitted work. BKN reports being a principal investigator or coinvestigator on research grants from the National Institutes of Health, the Veterans Affairs Health Services Research & Development, the American Heart Association, Apple, Inc, and Toyota; compensation as Editor-in-Chief of Circulation: Cardiovascular Quality & Outcomes, a journal of the American Heart Association; and is a coinventor on US Utility Patent Number US15/356 012 (US20170148158A1) titled “Automated analysis of vasculature in coronary angiograms” that uses software technology with signal processing and machine learning to automate the reading of coronary angiograms, held by the University of Michigan. The patent is licensed to AngioInsight, Inc, in which he holds ownership shares. HMK reports personal fees from UnitedHealth, IBM Watson Health, Element Science, Aetna, Facebook, F-Prime, Siegfried & Jensen Law Firm, Arnold & Porter Law Firm, Martin/Baughman Law Firm, and National Center for Cardiovascular Diseases, Beijing; serving as cofounder of HugoHealth, Refactor Health, and Centers for Medicare & Medicaid Services; and grants from Medtronic and the Food and Drug Administration, Medtronic and Johnson & Johnson, and Shenzhen Center for Health Information outside the submitted work. JPC reports receiving support from the American College of Cardiology, CMS, and Medtronic. RK, YL, SRD, AP, WO, SG, CR, KW, ZL, SMB, EJB, KBC report none.
Funding Information:
The Get With The Guidelines® programs are provided by the American Heart Association. The American Heart Association Precision Medicine Platform ( https://precision.heart.org/ ) was used for data analysis. IQVIA (Parsippany, New Jersey) serves as the data collection and coordination center. AHA's suite of Registries is funded by multiple industry sponsors. AHA's COVID-19 CVD Registry is partially supported by The Gordon and Betty Moore Foundation.
Funding Information:
Funding: RK received support from the National Heart, Lung, and Blood Institute of the National Institutes of Health under the grant 1K23HL153775. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Conflict of Interest: JAdL reports fees for participating in Data Monitoring Committees from Eli Lilly and Novo Nordisc and consulting income from Jannsen. DJK reports serving on the writing committee of the 2018 American Association for Thoracic Surgery/American College of Cardiology/Society for Cardiovascular Angiography and Interventions/Society of Thoracic Surgeons Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement. WRY reports grants and personal fees from Abbott Vascular, AstraZeneca, Medtronic, and Boston Scientific outside the submitted work. BKN reports being a principal investigator or coinvestigator on research grants from the National Institutes of Health, the Veterans Affairs Health Services Research & Development, the American Heart Association, Apple, Inc, and Toyota; compensation as Editor-in-Chief of Circulation: Cardiovascular Quality & Outcomes, a journal of the American Heart Association; and is a coinventor on US Utility Patent Number US15/356?012 (US20170148158A1) titled ?Automated analysis of vasculature in coronary angiograms? that uses software technology with signal processing and machine learning to automate the reading of coronary angiograms, held by the University of Michigan. The patent is licensed to AngioInsight, Inc, in which he holds ownership shares. HMK reports personal fees from UnitedHealth, IBM Watson Health, Element Science, Aetna, Facebook, F-Prime, Siegfried & Jensen Law Firm, Arnold & Porter Law Firm, Martin/Baughman Law Firm, and National Center for Cardiovascular Diseases, Beijing; serving as cofounder of HugoHealth, Refactor Health, and Centers for Medicare & Medicaid Services; and grants from Medtronic and the Food and Drug Administration, Medtronic and Johnson & Johnson, and Shenzhen Center for Health Information outside the submitted work. JPC reports receiving support from the American College of Cardiology, CMS, and Medtronic. RK, YL, SRD, AP, WO, SG, CR, KW, ZL, SMB, EJB, KBC report none.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11
Y1 - 2021/11
N2 - Background: Whether the volume of coronavirus disease 2019 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and future novel and rapidly evolving high-volume conditions. Methods: We identified COVID-19 hospitalizations at US hospitals in the American Heart Association COVID-19 Cardiovascular Disease Registry with ≥10 cases between January and August 2020. We evaluated the association of COVID-19 hospitalization volume and weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR). Results: There were 85 hospitals with 15,329 COVID-19 hospitalizations, with a median hospital case volume was 118 (interquartile range, 57, 252) and median growth rate of 2 cases per 100 beds per week but varied widely (interquartile range: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = .09). However, hospitals with more rapid COVID-19 case-growth had higher rsCFR (rho, 0.22, P = 0.047), increasing across case growth quartiles (P trend = .03). Although there were no differences in medical treatments or intensive care unit therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (odds ratio, 4.00; 1.15 to 13.8, P = .03). Conclusions: An accelerated case growth trajectory is a marker of hospitals at risk of poor COVID-19 outcomes, identifying sites that may be targets for influx of additional resources or triage strategies. Early identification of such hospital signatures is essential as our health system prepares for future health challenges.
AB - Background: Whether the volume of coronavirus disease 2019 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and future novel and rapidly evolving high-volume conditions. Methods: We identified COVID-19 hospitalizations at US hospitals in the American Heart Association COVID-19 Cardiovascular Disease Registry with ≥10 cases between January and August 2020. We evaluated the association of COVID-19 hospitalization volume and weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR). Results: There were 85 hospitals with 15,329 COVID-19 hospitalizations, with a median hospital case volume was 118 (interquartile range, 57, 252) and median growth rate of 2 cases per 100 beds per week but varied widely (interquartile range: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = .09). However, hospitals with more rapid COVID-19 case-growth had higher rsCFR (rho, 0.22, P = 0.047), increasing across case growth quartiles (P trend = .03). Although there were no differences in medical treatments or intensive care unit therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (odds ratio, 4.00; 1.15 to 13.8, P = .03). Conclusions: An accelerated case growth trajectory is a marker of hospitals at risk of poor COVID-19 outcomes, identifying sites that may be targets for influx of additional resources or triage strategies. Early identification of such hospital signatures is essential as our health system prepares for future health challenges.
KW - COVID-19
KW - Health services research
KW - Outcomes research
KW - Quality of care
KW - SARS-CoV2
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U2 - 10.1016/j.amjmed.2021.06.034
DO - 10.1016/j.amjmed.2021.06.034
M3 - Article
C2 - 34343515
AN - SCOPUS:85114768489
SN - 0002-9343
VL - 134
SP - 1380-1388.e3
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 11
ER -