Disclosure(s): No relevant financial relationship(s) to disclose.
First Author: Edgar M. Landa, N/A – Texas Tech University Health Sciences Center Co-Author: John Garza, PhD – Doctor, Texas Tech University Health Sciences Center at the Permian Basin Co-Author: Hamza Khair, MD – Texas Tech University Health Sciences Center at the Permian Basin Co-Author: Anu Twayana, N/A Co-Author: Abira Usman, N/A Co-Author: Lavi Oud, MD – Dr., Texas Tech University Health Sciences Center
Introduction: The use of mechanical ventilation in patients with dementia has increased over time. The COVID-19 pandemic strained critical care resources and was associated with increased mortality among mechanically ventilated patients in the general population. However, the population-level mortality trends in mechanically ventilated patients with dementia before and during the pandemic have not been examined.
Methods: Statewide data were used to identify mechanically ventilated hospitalizations aged ≥65 years with dementia in Texas during 2016-2023. Dementia was defined by previously reported ICD-10-based taxonomy and COVID-19 by ICD-10 code U071. Interrupted time series analyses (ITSA) with segmented hierarchical logistic models were used to estimate the prepandemic (1/1/2016-3/31/2020) trend, level (intercept) change, pandemic (4/1/2020-12/31/2023) trend, and change in trends in short-term mortality (defined as in-hospital death or discharge to hospice) among mechanically ventilated hospitalizations with dementia overall and on sensitivity analyses of non-COVID hospitalizations. Results were expressed as average marginal effects (AME), indicating changes in the absolute probability of death.
Results: There were 36,851 mechanically ventilated hospitalizations with dementia (65% prepandemic; 35% during pandemic; 53.2% female; 49.0% racial or ethnic minority; 6.4% with COVID-19). Short-term mortality during the prepandemic and pandemic periods was 50.2% and 59.1%, respectively. On ITSA, short-term mortality declined during the prepandemic period (AME -0.13%/quarter [95% CI -0.23% to -0.02%]), with level change (AME 3.7%, [95% CI 1.93% to 5.4%]), but with subsequent mortality downtrend during the pandemic (AME -0.22%/quarter [95% CI -0.39% to -0.06%]) and no difference between trends (p=0.3274). Findings were similar among non-COVID hospitalizations, except for unchanged mortality during the pandemic period (AME -0.04%/quarter [95% CI -0.22% to 0.14%]).
Conclusions: There was a dramatic decrease in use of mechanical ventilation in patients with dementia during the COVID-19 pandemic. Short-term mortality was high but decreased during the prepandemic years. These outcome gains were stalled by the pandemic, with persistently higher mortality among non-COVID patients compared to the prepandemic period.
