Outcomes of COVID-19 Admissions in the New York City Public Health System and Variations by Hospitals and Boroughs During the Initial Pandemic Response

Introduction: In the initial pandemic regional differences may have existed in COVID-19 hospitalizations and patient outcomes in New York City. Whether these patterns were present in public hospitals is unknown. The aim of this brief study was to investigate COVID-19 hospitalizations and outcomes in the public health system during the initial pandemic response.

Methods: A retrospective review was conducted on COVID-19 admissions in New York City public hospitals during the exponential phase of the pandemic. All data were collected from an integrated electronic medical records system (Epic Health Systems, Verona, WI). Overall, 5,422 patients with at least one admission each for COVID-19 were reviewed, with a study of demographic characteristics (including age, gender, race, BMI), pregnancy status, comorbidities, facility activity, and outcomes. Data related to hospitalization and mortality trends were also collected from City of New York website. These data often involved more than one facility and/or service line resulting in more location or treatment facility counts than patients due to utilization of services at more than one location and transfers between locations and facilities.

Results: Higher mortality was associated with increasing age with the highest death rate (51.9%) noted in the age group >75 years (OR 7.88, 95%CI 6.32–10.08). Comorbidities with higher mortality included diabetes (OR 1.5, 95% CI 1.33–1.70), hypertension (OR 1.62, 95% CI 1.44–1.83), cardiovascular conditions (OR 1.66, 95% CI 1.47–1.87), COPD (OR 1.86, 95% CI 1.39–2.50). It was deduced that 20% of all New York City COVID-19 positive admissions were in public health system during this timeframe. A high proportion of admissions (21.26%) and deaths (19.93%) were at Elmhurst Hospital in Queens. Bellevue and Metropolitan Hospitals had the lowest number of deaths, both in borough of Manhattan. Mortality in public hospitals in Brooklyn was 29.9%, Queens 28.1%, Manhattan 20.4%.

Conclusion: Significant variations existed in COVID-19 hospitalizations and outcomes in the public health system in New York City during the initial pandemic. Although outcomes are worse with older age and those with comorbidities, variations in hospitals and boroughs outside of Manhattan are targets to investigate and strategize efforts.

Characteristics, comorbidities and survival analysis of young adults hospitalized with COVID-19 in New York City

This study reviewed 395 young adults, 18–35 year-old, admitted for COVID-19 to one of the eleven hospitals in New York City public health system. Demographics, comorbidities, clinical course, outcomes and characteristics linked to hospitalization were analyzed including temporal survival analysis. Fifty-seven percent of patients had a least one major comorbidity. Mortality without comorbidity was in 3.8% patients. Further investigation of admission features and medical history was conducted. Comorbidities associated with mortality were diabetes (n = 54 deceased/73 diagnosed,74% tested POS;98.2% with diabetic history deceased; Wilcoxon p (Wp) = .044), hypertension (14/44,32% POS, 25.5%; Wp = 0.030), renal (6/16, 37.5% POS,11%; Wp = 0.000), and cardiac (6/21, 28.6% POS,11%; Wp = 0.015). Kaplan survival plots were statistically significant for these four indicators. Data suggested glucose >215 or hemoglobin A1c >9.5 for young adults on admission was associated with increased mortality. Clinically documented respiratory distress on admission was statistically significant outcome related to mortality (X² = 236.6842, df = 1, p < .0001). Overall, 28.9% required supportive oxygen beyond nasal cannula. Nasal cannula oxygen alone was required for 71.1%, who all lived. Non-invasive ventilation was required for 7.8%, and invasive mechanical ventilation 21.0% (in which 7.3% lived, 13.7% died). Temporal survival analysis demonstrated statistically significant response for Time to Death <10 days (X² = 18.508, df = 1, p = .000); risk lessened considerably for 21 day cut off (X² = 3.464, df = 1, p = .063), followed by 31 or more days of hospitalization (X² = 2.212, df = 1, p = .137).

Abstract 262: A Comparative Study of the Efficiency of Non-Invasive Imaging Modalities in the Evaluation of Outpatient Chest Pain and the Sequential Relationship between Coronary Imaging Modalities Leading to Percutaneous Coronary Interventions at the Patient Level

Background: As catheterizations can lead to complications, assessing chest pain patients for coronary artery disease with non-invasive methods has the potential to improve the quality of care. However, there is limited evidence comparing subsequent procedures following initial assessments. To investigate the role of coronary computed tomographic angiography (CCTA) as an initial assessment, this study had two aims: 1) quantify catheterizations following initial non-invasive workups, and 2) evaluate the rate of stent placement following either initial CCTA assessment or catheterization without CCTA.

Methods: This was a retrospective analysis using administrative claims data from a large, national health insurer with a cardiac utilization management program. To assess the first aim, patients diagnosed with chest pain who received one of the following initial assessments in 2010 were selected: stress echocardiogram (STE), cardiac nuclear scan (CNUC), or CCTA. Continuous enrollment for 24 months after the initial assessment and no prior chest pain diagnosis or related-procedure in the year prior to the index procedure was required. The number of patients receiving 1, 2, and 3 procedures, as well as the proportion of patients with a catheterization following their initial assessment was reported. To assess the second aim, patients who had either an initial CCTA or a catheterization with no CCTA during 2011-2012 were selected. Patients receiving a stent prior to the CCTA or catheterization were excluded. The rate of stent placement in the 30 days after the initial CCTA assessment or the catheterization was compared for each group using a two-tailed t-test.

Results: CNUC was the most common initial procedure. Among the initial assessments, 50.4% of Medicare patients with CNUC had a catheterization, compared to 26.8% with CCTA and 21.6% with STE. Most of the Medicare patients had 1 procedure; 36.1% had 2 or more procedures and 12.0% had 3 procedures. The evaluation of stent placement found that stents were more common in the group that had a catheterization but no CCTA (22.2%) compared to the group that had an initial CCTA assessment (7.4%), p<0.001. Among those with an initial CCTA, 30.2% had a catheterization and 24.6% of those went on to have a stent. The difference in the rate of transition from catheterization to stent in the two populations was not statistically significant, p=0.37.

Conclusions: These results suggest that CCTA or STE as an initial, non-invasive cardiac procedure may reduce cardiac catheterization, thereby reducing radiation exposure and risk of complications from invasive tests. The rate of stent placement was lower among those who had an initial CCTA assessment, compared to when catheterization was used alone. CCTA’s role can be clarified through prospective, randomized studies.