Association of Coronavirus Disease-19 Hospitalization Volume and Case Growth at United States Hospitals with Patient Outcomes

Khera, Rohan; Liu, Yusi; de Lemos, James A; Das, Sandeep R; Pandey, Ambarish; Omar, Wally; Kumbhani, Dharam J; Girotra, Saket; Yeh, Robert W; Rutan, Christine; Walcoch, Jason; Lin, Zhenqiu; Bradley, Steven M; Velazquez, Eric J; Churchwell, Keith B; Nallamothu, Brahmajee K.; Krumholz, Harlan M; Curtis, Jeptha P

BACKGROUND: Whether the volume of coronavirus disease-19 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and also future novel and rapidly evolving high-volume conditions. METHODS: We identified COVID-19 hospitalizations at US hospitals in the American Heart Association COVID-19 Cardiovascular Disease Registry with ≥10 cases between January and August 2020. We evaluated the association of (1) COVID-19 hospitalization volume and 2) weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR). RESULTS: There were 85 hospitals with 15329 COVID-19 hospitalizations, with a median hospital case volume was 118 (IQR, 57, 252) and median growth rate of 2 cases/100 beds/week but varied widely (IQR: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = 0.09). However, hospitals with more rapid COVID-19 case-growth had higher rsCFR (rho, 0.22, P = 0.047), increasing across case growth quartiles (P-trend, 0.03). While there were no differences in medical treatments or ICU therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (OR, 4.00; 1.15 to 13.8, P = 0.03). CONCLUSIONS: An accelerated case growth trajectory is a marker of hospitals at risk of poor COVID-19 outcomes, identifying sites that may be targets for influx of additional resources or triage strategies. Early identification of such hospital signatures is essential as our health system prepares for future health challenges.