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Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe

2022-09Artigo científico Acesso aberto
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dc.contributor.authorWernly, Bernhard
dc.contributor.authorRezar, Richard
dc.contributor.authorFlaatten, Hans
dc.contributor.authorBeil, Michael
dc.contributor.authorFjølner, Jesper
dc.contributor.authorBruno, Raphael Romano
dc.contributor.authorArtigas, Antonio
dc.contributor.authorPinto, Bernardo Bollen
dc.contributor.authorSchefold, Joerg C
dc.contributor.authorKelm, Malte
dc.contributor.authorSigal, Sviri
dc.contributor.authorvan Heerden, Peter Vernon
dc.contributor.authorSzczeklik, Wojciech
dc.contributor.authorElhadi, Muhammed
dc.contributor.authorJoannidis, Michael
dc.contributor.authorOeyen, Sandra
dc.contributor.authorWolff, Georg
dc.contributor.authorMarsh, Brian
dc.contributor.authorAndersen, Finn H
dc.contributor.authorMoreno, Rui
dc.contributor.authorLeaver, Susannah
dc.contributor.authorWernly, Sarah
dc.contributor.authorBoumendil, Ariane
dc.contributor.authorDe Lange, Dylan W
dc.contributor.authorGuidet, Bertrand
dc.contributor.authorJung, Christian
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblElsevier Science B.V., Amsterdam.
dc.date.accessioned2022-04-27T22:45:08Z
dc.date.available2022-04-27T22:45:08Z
dc.date.issued2022-09
dc.description.abstractBACKGROUND: Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe. OBJECTIVES: The purpose of this post-hoc analysis of the prospective multi-centre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic. METHODS: A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aOR) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (GDP, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day-mortality was a secondary outcome. RESULTS: The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%), and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95%CI 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78). CONCLUSION: This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results. This article is protected by copyright. All rights reserved.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent591413
dc.identifier.doi10.1111/joim.13492
dc.identifier.issn0953-6205
dc.identifier.otherPURE: 43361658
dc.identifier.otherPURE UUID: ab3f346d-f3a4-4a1e-b6f9-d9ad47fe84a6
dc.identifier.otherPubMed: 35398948
dc.identifier.otherWOS: 000787027500001
dc.identifier.otherScopus: 85134186145
dc.identifier.urihttp://hdl.handle.net/10362/137069
dc.language.isoeng
dc.peerreviewedyes
dc.subjectCOVID-19
dc.subjectcritical care
dc.subjectfrail elderly
dc.subjectpublic health systems research
dc.subjectresuscitation orders
dc.titleVariations in end-of-life care practices in older critically ill patients with COVID-19 in Europeen
dc.typejournal article
degois.publication.firstPage438
degois.publication.issue3
degois.publication.lastPage449
degois.publication.titleJournal of Internal Medicine
degois.publication.volume292
dspace.entity.typePublication
rcaap.rightsopenAccess

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