Deans' stroke musings: Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, January 5, 2021

Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19

Your doctor's responsibility is to make sure you are not impaired cognitively or physically so you have a lower chance of dying from COVID-19.

Your doctor needs EXACT STROKE PROTOCOLS to recover your lost 5 cognitive years from the stroke.

You are pretty much screwed on physically recovering since only 10% get to rehab full recovery

Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19

Orestis A. Panagiotou, MD, PhD^1,2,3; Cyrus M. Kosar, MA^1,2; Elizabeth M. White, PhD, APRN^1,2; et al Leonidas E. Bantis, PhD⁴; Xiaofei Yang, ScM²; Christopher M. Santostefano, BSN, RN²; Richard A. Feifer, MD, MPH^5,6; Carolyn Blackman, MD^5,6; James L. Rudolph, MD^1,2,3; Stefan Gravenstein, MD, MPH^1,2,3,7; Vincent Mor, PhD^1,2,3

Author Affiliations Article Information

JAMA Intern Med. Published online January 4, 2021. doi:10.1001/jamainternmed.2020.7968

Key Points

Question What patient characteristics are associated with 30-day all-cause mortality among symptomatic nursing home residents with coronavirus disease 2019 (COVID-19)?

Findings In this cohort study of 5256 US nursing home residents with COVID-19, increased age, male sex, and impaired cognitive and physical function were independent risk factors for all-cause 30-day mortality.

Meaning This cohort study of 5256 nursing home residents suggests that several characteristics, including sociodemographic characteristics, symptoms, comorbidities, and physical and cognitive functional impairments, can facilitate risk stratification among nursing home residents with COVID-19.

Abstract

Importance The coronavirus disease 2019 (COVID-19) pandemic has severely affected nursing homes. Vulnerable nursing home residents are at high risk for adverse outcomes, but improved understanding is needed to identify risk factors for mortality among nursing home residents.

Objective To identify risk factors for 30-day all-cause mortality among US nursing home residents with COVID-19.

Design, Setting, and Participants This cohort study was conducted at 351 US nursing homes among 5256 nursing home residents with COVID-19–related symptoms who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction testing between March 16 and September 15, 2020.

Exposures Resident-level characteristics, including age, sex, race/ethnicity, symptoms, chronic conditions, and physical and cognitive function.

Main Outcomes and Measures Death due to any cause within 30 days of the first positive SARS-CoV-2 test result.

Results The study included 5256 nursing home residents (3185 women [61%]; median age, 79 years [interquartile range, 69-88 years]; and 3741 White residents [71%], 909 Black residents [17%], and 586 individuals of other races/ethnicities [11%]) with COVID-19. Compared with residents aged 75 to 79 years, the odds of death were 1.46 (95% CI, 1.14-1.86) times higher for residents aged 80 to 84 years, 1.59 (95% CI, 1.25-2.03) times higher for residents aged 85 to 89 years, and 2.14 (95% CI, 1.70-2.69) times higher for residents aged 90 years or older. Women had lower risk for 30-day mortality than men (odds ratio [OR], 0.69 [95% CI, 0.60-0.80]). Two comorbidities were associated with mortality: diabetes (OR, 1.21 [95% CI, 1.05-1.40]) and chronic kidney disease (OR, 1.33 [95%, 1.11-1.61]). Fever (OR, 1.66 [95% CI, 1.41-1.96]), shortness of breath (OR, 2.52 [95% CI, 2.00-3.16]), tachycardia (OR, 1.31 [95% CI, 1.04-1.64]), and hypoxia (OR, 2.05 [95% CI, 1.68-2.50]) were also associated with increased risk of 30-day mortality. Compared with cognitively intact residents, the odds of death among residents with moderate cognitive impairment were 2.09 (95% CI, 1.68-2.59) times higher, and the odds of death among residents with severe cognitive impairment were 2.79 (95% CI, 2.14-3.66) times higher. Compared with residents with no or limited impairment in physical function, the odds of death among residents with moderate impairment were 1.49 (95% CI, 1.18-1.88) times higher, and the odds of death among residents with severe impairment were 1.64 (95% CI, 1.30-2.08) times higher.

Conclusions and Relevance In this cohort study of US nursing home residents with COVID-19, increased age, male sex, and impaired cognitive and physical function were independently associated with mortality. Understanding these risk factors can aid in the development of clinical prediction models of mortality in this population.