(314) Impact of COVID-19 on Short-Term Mortality in Critically Ill Patients With Cardiomyopathy

Introduction: The COVID-19 pandemic has strained the healthcare system and was associated with increased mortality among many non-COVID-19 critically ill patients. However, the impact on those with cardiomyopathy (CM) is unclear. We conducted a population-level analysis of the impact of the pandemic on short-term mortality of ICU admissions with a principal diagnosis of cardiomyopathy.

Methods: We used a publicly available, deidentified, and statewide dataset to identify ICU admissions aged ≥18 years with a principal diagnosis of cardiomyopathy in Texas during 2016-2022. CM was identified using ICD-10 codes from Clinical Classification Software Refined category CIR005. COVID-19 was identified using ICD-10 code U071. Short-term mortality was defined as in-hospital death or discharge to hospice. Interrupted time series analysis (ITSA) using multilevel logistic regression was used to determine the pre-pandemic (Q1 2016 - Q12020) trend, level (intercept) change, pandemic (Q2 2020 - Q4 2022) trend, and change in trends in short-term mortality among ICU admissions with cardiomyopathy. Results are reported as average marginal effects (AME), indicating a change in the absolute probability of death. Sensitivity analyses included those without COVID-19, age ≥65, and the mechanically ventilated.

Results: There were 418,112 total ICU admissions with cardiomyopathy during the study period, 255,189 in the pre-pandemic period, and 162,923 in the pandemic period. Out of which, 57.4% were aged ≥65 years, 48.2% were racial/ethnic minority, and 2.4% had COVID-19. Short-term mortality during the pre-pandemic and pandemic periods was 10.1% and 11.7%, respectively. On ITSA, short-term mortality was decreasing during the pre-pandemic period (AME -0.10%/quarter [95% CI -0.12 to -0.08]), with level change (AME 1.87% [95% CI 1.56 to 2.18]), and also decreasing during the pandemic period but at lower rate (AME -0.08%/quarter [95% CI -0.12 to -0.05]), with insignificant trend change (p=0.3424). Sensitivity analyses had similar results to the primary model.

Conclusions: The COVID-19 pandemic increased short-term mortality of critically ill patients with CM. However, the decreasing time trend in mortality pre-pandemic remained during the pandemic period.