Association of COVID-19 Hospitalization Volume and Case Growth at US Hospitals with Patient Outcomes

doi:10.1016/j.amjmed.2021.06.034

The American Journal of Medicine

Volume 134, Issue 11, November 2021, Pages 1380-1388.e3

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https://doi.org/10.1016/j.amjmed.2021.06.034 Get rights and content

Abstract

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.

Keywords

COVID-19

Health services research

Outcomes research

Quality of care

SARS-CoV2

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: 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.

: Authorship: All authors had access to the data and a role in writing this manuscript.

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