Cardiovascular diseases and covid-19 in-hospital mortality: insights from a retrospective study in a rural academic hospital

SESSION TITLE: Chest Infections Posters 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Mortality associated with COVID-19 disease is multifactorial. Various COVID-19 related mortality risk factors may differ as per the geographical distribution, health care settings, patient population and socio-economic factors. It is very important to understand the underlying driving forces for COVID-19 related in-hospital mortality (IHM) in the particular area to formulate the appropriate implementation strategies. Assessment of such factors associated with COVID-19 mortality may guide the health care professionals in making decisions for the better patient outcomes. Therefore, we aim to examine the characteristics and clinical outcomes of COVID-19 patients in intensive care unit (ICU) in a rural academic hospital. Additionally, we believe that our study results may help in making implementation strategies at primary care level, focusing on the modifiable risk factors associated with COVID-19 IHM. METHODS: This is a retrospective study of the COVID-19 patients managed in ICU of a rural academic hospital in a health professional shortage area (HPSA). Among 278 eligible patients, 89 patients expired during the treatment and are included in expired group (EG) whereas, 179 patients are included in non-expired group (NEG). Differences in mean and percentage of baseline characteristics and clinical outcomes between the two groups were analyzed using unpaired t-tests and Chi-squared tests respectively. Institutional review board of Cayuga Medical Center exempted this study from the review. RESULTS: A higher number of elderly patients were found in the EG as compared to NEG (mean age 72 vs 65, P=0.0008). Majority of the patients were male (59.6% vs 56%), White (58.5% vs 51.4%) and obese (mean body mass index 29.3 vs 31.5 kg/m2) in EG and NEG respectively. Cardiovascular disease (CVD) risks like current smoking status (17% vs 5.6%, P=0.003), diabetes mellitus (DM) (45% vs 30.2%, P=0.02), hypertension (HTN) (72% vs 58.7%, P=0.04), coronary artery diseases (CAD) (38.2% vs 23.5%, P=0.01) and Atrial fibrillation (27% vs 16.2%, P=0.04) were found in higher proportion among EG as compared to NEG. Only 2.2% vs 4% had ST segment elevation myocardial infarction, 1% vs 4.5% had non-ST segment elevation myocardial infarction and 2.2% vs 6.7% underwent cardiac catheterization between the two groups with no statistical significance. Mean length of hospital stay were 4 vs 5.5 days (P=0.05), ICU stay were 7.6 vs 4.7 days (P=0.0002) and mechanical ventilator use were 2.3 vs 1 day (P=0.02) between the two groups. 34.8% patients in EG and 10% in NEG required intubation and mechanical ventilation (P=<0.0001). CONCLUSIONS: Our study outlines the plausible association of CVD risk factors with COVID-19 IHM. Incorporation of Telemedicine (TM) based CVD management approach along with the post COVID-19 care clinic may play a promising role at primary care level especially in HPSA like ours. Such CVD conscious implementation strategies may help in mitigating the fatal but preventable COVID-19 outcomes. CLINICAL IMPLICATIONS: Implementation of robust primary prevention strategies for modifiable CVD risks like HTN, CAD, DM, smoking status may help in mitigating the fatal outcomes of COVID-19 disease. Appropriate formulation and assessment of feasibility of TM based CVD management strategies along with COVID-19 care clinic is a real need. DISCLOSURES: No relevant relationships by Sameer Acharya No relevant relationships by Sushilkumar Gupta No relevant relationships by Douglas MacQueen No relevant relationships by Aamod Tiwari No relevant relationships by Yogesh Yadav