Decreased Mortality Over Time During the First Wave in Patients With COVID-19 in Geriatric Care: Data From the Stockholm GeroCovid Study.
Hong Xu, Sara Garcia-Ptacek, Martin Annetorp and 14 others
PMID 34216553WHAT IT FOUND
Older hospitalized patients with COVID-19 in Stockholm had lower in-hospital death rates when admitted later: 27.7% in March and 2.9% in July.
Low oxygen saturation was associated with death but explained only 8% of the decline.
Key findings
01In-hospital death among older patients with COVID-19 fell across admission months: 27.7% in March, 17.8% in April, 9.9% in May, 7.7% in June, and 2.9% in July.
02After adjustment for age, sex, initial vital signs, and medications, the paper reported lower in-hospital death risk than March by 29% in April, 61% in May, 68% in June, and 86% in July.
03Low admission saturation was associated with death and explained 8% of the mortality decline, but the decline was not seen in patients with saturation below 90%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is observational, so the lower death rate later in the wave cannot be treated as proof that any treatment or care change caused it. Only in-hospital death was counted, and the authors note that discharge outcomes were unavailable, so the mortality rate may be underestimated. Patients in nursing homes and patients treated in intensive care or infectious disease wards were largely not included, so the results do not describe all older frail patients with COVID-19. Medications were recorded only within 24 hours of admission, so later treatment changes and medication dose could not be assessed. July had only 69 patients with COVID-19, so the July estimate is based on a small number. The authors did not have comorbidity data beyond discharge diagnoses and did not adjust for those diagnoses.
The easy way to misread this
Do not conclude that the later lower mortality was caused by a specific treatment or by improved care. This was an observational study of in-hospital death, medications were recorded only within 24 hours of admission, and anticoagulants and corticosteroids were not associated with mortality in these analyses.