Comorbidities, symptoms and end-of-life medication use in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada
Shirley H Bush,
Monisha Kabir,
Peter Lawlor,
James Downar,
Brandi Vanderspank-Wright,
Sarina Isenberg,
Peter Tanuseputro,
Akshai Iyengar,
Claire Dyason,
Julie Lapenskie,
Colleen Webber,
Henrique Parsons,
Samantha Rose Adeli,
Ella Besserer,
Leila Cohen,
Valérie Gratton,
Rebekah Murphy,
Grace Warmels,
Adrianna Bruni,
Chelsea Noel,
Brandon Heidinger,
Koby Anderson,
Kyle Arsenault-Mehta,
Krista Wooller,
Daniel Bedard,
Paula Enright,
Isabelle Desjardins,
Khadija Bhimji
Affiliations
Shirley H Bush
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Monisha Kabir
Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
Peter Lawlor
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
James Downar
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Brandi Vanderspank-Wright
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Sarina Isenberg
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Peter Tanuseputro
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Akshai Iyengar
Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
Claire Dyason
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Julie Lapenskie
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Colleen Webber
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Henrique Parsons
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Samantha Rose Adeli
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
Ella Besserer
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
Leila Cohen
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Valérie Gratton
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Rebekah Murphy
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Grace Warmels
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Adrianna Bruni
Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
Chelsea Noel
Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
Brandon Heidinger
Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
Koby Anderson
Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
Kyle Arsenault-Mehta
Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
Krista Wooller
Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
Daniel Bedard
Institut du Savoir Montfort, Ottawa, Ontario, Canada
Paula Enright
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Isabelle Desjardins
Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
Khadija Bhimji
Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
Objective To compare comorbidities, symptoms and end-of-life (EoL) palliative medication (antisecretories, opioids, antipsychotics and sedatives) use among decedents before and during the COVID-19 pandemic.Design In a retrospective cohort study, decedent records in three acute care hospitals were abstracted, generating a prepandemic (November 2019–February 2020) group (pre-COVID) and two intrapandemic (March–August 2020, wave 1) groups, one without (COVID-ve) and one with COVID-19 infection (COVID+ve). Control group decedents were matched 2:1 on age, sex and care service (medicine/intensive care unit (ICU)) with COVID+ve decedents.Setting Three regional acute care teaching hospitals in Ottawa, CanadaParticipants Decedents (N=425): COVID+ve (n=85), COVID-ve (n=170) and pre-COVID (n=170).Main outcome measures Data were abstracted regarding demographics, admission comorbidities and symptoms, and EoL medication use; opioid doses were standardised to parenteral morphine equivalent daily dose (MEDD), and the predictors of upper quartile MEDD in the last 24 hours of life were examined in multivariable logistic regression with adjusted ORs (aORs) and 95% CIs.Results The prevalence of dementia (41% vs 28% and 26%, p=0.03), breathlessness (63.5% vs 42% and 47%, p<0.01), cough (40% vs 27% and 19%, p<0.01) and fever (54% vs 9% and 13.5%) was higher in COVID+ve versus pre-COVID and COVID-ve groups, respectively. The median (IQR) of MEDD over the last 72 hours of life was 16.7 (9–36.5) vs 13.5 (5.7–21.8) and 10.5 (5.3–23.8) for COVID+ve versus pre-COVID and COVID-ve groups, respectively, (p=0.007). Male sex, COVID+ve grouping, ICU death and high-flow nasal cannula use predicted upper quartile MEDD dose, aORs (95% CIs): 1.84 (1.05 to 3.22), 2.62 (1.29 to 5.3), 5.14 (2.47 to 10.7) and 1.93 (1.05 to 3.52), respectively. COVID+ve group decedents used highest lorazepam and propofol doses.Conclusions COVID-19 decedents, particularly those in ICU, required higher EoL opioid and sedating medication doses than matched prepandemic or intrapandemic controls. These findings should inform and guide clinical practice.