TY - JOUR
T1 - Mortality and the Use of Antithrombotic Therapies Among Nursing Home Residents withCOVID-19
AU - Brouns, Steffie H.
AU - Bruggemann, Renee
AU - Linkens, Aimee E. M. J. H.
AU - Magdelijns, Fabienne J.
AU - Joosten, Hanneke
AU - Heijnen, Ron
AU - ten Cate-Hoek, Arina J.
AU - Schols, Jos M. G. A.
AU - ten Cate, Hugo
AU - Spaetgens, Bart
PY - 2020/8
Y1 - 2020/8
N2 - BACKGROUND/OBJECTIVES 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 A retrospective case series. SETTING FourteenNHfacilities from theNHorganization Envida, Maastricht, the Netherlands PARTICIPANTS A total of 101 NH residents with COVID-19 were enrolled. MEASUREMENTS The primary outcome was all-cause mortality. The association between age, sex, comorbidity, OAT, and mortality was assessed using logistic regression analysis. 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 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.
AB - BACKGROUND/OBJECTIVES 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 A retrospective case series. SETTING FourteenNHfacilities from theNHorganization Envida, Maastricht, the Netherlands PARTICIPANTS A total of 101 NH residents with COVID-19 were enrolled. MEASUREMENTS The primary outcome was all-cause mortality. The association between age, sex, comorbidity, OAT, and mortality was assessed using logistic regression analysis. 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 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.
KW - COVID-19
KW - mortality
KW - nursing home
KW - older people
KW - thromboembolic complications
KW - COMPLICATIONS
U2 - 10.1111/jgs.16664
DO - 10.1111/jgs.16664
M3 - Article
C2 - 32633418
VL - 68
SP - 1647
EP - 1652
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 8
ER -