Mortality and the Use of Antithrombotic Therapies Among Nursing Home Residents with COVID-19.
Aged
Aged, 80 and over
Betacoronavirus
COVID-19
Coronavirus Infections
/ complications
Female
Fibrinolytic Agents
/ therapeutic use
Homes for the Aged
Humans
Incidence
Male
Netherlands
/ epidemiology
Nursing Homes
Odds Ratio
Pandemics
Pneumonia, Viral
/ complications
Retrospective Studies
SARS-CoV-2
Sex Factors
Thromboembolism
/ drug therapy
COVID-19 Drug Treatment
COVID-19
mortality
nursing home
older people
thromboembolic complications
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
20
05
2020
revised:
26
05
2020
accepted:
29
05
2020
pubmed:
8
7
2020
medline:
1
9
2020
entrez:
8
7
2020
Statut:
ppublish
Résumé
Nursing home (NH) residents are a vulnerable population, susceptible to respiratory disease outbreaks such as coronavirus disease 2019 (COVID-19). Poor outcome in COVID-19 is at least partly attributed to hypercoagulability, resulting in a high incidence of thromboembolic complications. It is unknown whether commonly used antithrombotic therapies may protect the vulnerable NH population with COVID-19 against mortality. This study aimed to investigate whether the use of oral antithrombotic therapy (OAT) was associated with a lower mortality in NH residents with COVID-19. A retrospective case series. Fourteen NH facilities from the NH organization Envida, Maastricht, the Netherlands PARTICIPANTS: A total of 101 NH residents with COVID-19 were enrolled. The primary outcome was all-cause mortality. The association between age, sex, comorbidity, OAT, and mortality was assessed using logistic regression analysis. Overall mortality was 47.5% in NH residents from 14 NH facilities. Age, comorbidity, and medication use were comparable among NH residents who survived and who died. OAT was associated with a lower mortality in NH residents with COVID-19 in the univariable analysis (odds ratio (OR) = 0.89; 95% confidence interval (CI) = 0.41-1.95). However, additional adjustments for sex, age, and comorbidity attenuated this difference. Mortality in males was higher compared with female residents (OR = 3.96; 95% CI = 1.62-9.65). Male residents who died were younger compared with female residents (82.2 (standard deviation (SD) = 6.3) vs 89.1 (SD = 6.8) years; P < .001). NH residents in the 14 facilities we studied were severely affected by the COVID-19 pandemic, with a mortality of 47.5%. Male NH residents with COVID-19 had worse outcomes than females. We did not find evidence for any protection against mortality by OAT, necessitating further research into strategies to mitigate poor outcome of COVID-19 in vulnerable NH populations. J Am Geriatr Soc 68:1647-1652, 2020.
Sections du résumé
BACKGROUND/OBJECTIVES
OBJECTIVE
Nursing home (NH) residents are a vulnerable population, susceptible to respiratory disease outbreaks such as coronavirus disease 2019 (COVID-19). Poor outcome in COVID-19 is at least partly attributed to hypercoagulability, resulting in a high incidence of thromboembolic complications. It is unknown whether commonly used antithrombotic therapies may protect the vulnerable NH population with COVID-19 against mortality. This study aimed to investigate whether the use of oral antithrombotic therapy (OAT) was associated with a lower mortality in NH residents with COVID-19.
DESIGN
METHODS
A retrospective case series.
SETTING
METHODS
Fourteen NH facilities from the NH organization Envida, Maastricht, the Netherlands PARTICIPANTS: A total of 101 NH residents with COVID-19 were enrolled.
MEASUREMENTS
METHODS
The primary outcome was all-cause mortality. The association between age, sex, comorbidity, OAT, and mortality was assessed using logistic regression analysis.
RESULTS
RESULTS
Overall mortality was 47.5% in NH residents from 14 NH facilities. Age, comorbidity, and medication use were comparable among NH residents who survived and who died. OAT was associated with a lower mortality in NH residents with COVID-19 in the univariable analysis (odds ratio (OR) = 0.89; 95% confidence interval (CI) = 0.41-1.95). However, additional adjustments for sex, age, and comorbidity attenuated this difference. Mortality in males was higher compared with female residents (OR = 3.96; 95% CI = 1.62-9.65). Male residents who died were younger compared with female residents (82.2 (standard deviation (SD) = 6.3) vs 89.1 (SD = 6.8) years; P < .001).
CONCLUSION
CONCLUSIONS
NH residents in the 14 facilities we studied were severely affected by the COVID-19 pandemic, with a mortality of 47.5%. Male NH residents with COVID-19 had worse outcomes than females. We did not find evidence for any protection against mortality by OAT, necessitating further research into strategies to mitigate poor outcome of COVID-19 in vulnerable NH populations. J Am Geriatr Soc 68:1647-1652, 2020.
Identifiants
pubmed: 32633418
doi: 10.1111/jgs.16664
pmc: PMC7361386
doi:
Substances chimiques
Fibrinolytic Agents
0
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1647-1652Informations de copyright
© 2020 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.
Références
J Am Coll Cardiol. 2020 Jul 7;76(1):122-124
pubmed: 32387623
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
J Am Geriatr Soc. 2020 Jul;68(7):E36-E37
pubmed: 32343395
Thromb Res. 2020 Jul;191:9-14
pubmed: 32353746
J Am Med Dir Assoc. 2017 Dec 1;18(12):1037-1042
pubmed: 28870834
N Engl J Med. 2020 May 28;382(22):2081-2090
pubmed: 32329971
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
Radiology. 2020 Oct;297(1):E216-E222
pubmed: 32324101
Clin Interv Aging. 2013;8:1489-96
pubmed: 24235821
Thromb Res. 2020 Jul;191:148-150
pubmed: 32381264
J Thromb Haemost. 2020 Apr;18(4):844-847
pubmed: 32073213
Am J Physiol Lung Cell Mol Physiol. 2018 Apr 1;314(4):L642-L653
pubmed: 29351446
N Engl J Med. 2020 May 21;382(21):2005-2011
pubmed: 32220208
Lancet Haematol. 2020 Jun;7(6):e438-e440
pubmed: 32407672
J Thromb Haemost. 2020 May;18(5):1094-1099
pubmed: 32220112
Nat Rev Endocrinol. 2018 Oct;14(10):576-590
pubmed: 30046148
J Am Geriatr Soc. 2020 Jun;68(6):E19-E23
pubmed: 32383809