Anticoagulant treatment and COVID-19 mortality among older adults living in nursing homes in Sweden

Laura Kananen; Christian Molnár; Fredrik Ansker; Daria Julianna Kozlowska; Sara Hägg; Juulia Jylhävä; Dorota Religa; Pauline Raaschou

doi:10.1002/hsr2.1692

Anticoagulant treatment and COVID-19 mortality among older adults living in nursing homes in Sweden

Laura Kananen
, Christian Molnár^*
, Fredrik Ansker
, Daria Julianna Kozlowska
, Sara Hägg
, Juulia Jylhävä
, Dorota Religa
, Pauline Raaschou

^*Tämän työn vastaava kirjoittaja

Tutkimustuotos: Artikkeli › Tieteellinen › vertaisarvioitu

2 Sitaatiot (Scopus)

29 Lataukset (Pure)

Abstrakti

Background: Anticoagulants (AC) were introduced in March 2020 as standard of care in nursing home (NH) residents affected with COVID-19 in the Stockholm region, Sweden. ACs are proven to reduce the risk of complications and mortality from COVID-19 among patients of other ages and settings, but there is limited scientific evidence underpinning this practice in the NH setting. Methods: This matched cohort study included 182 NH residents in the Stockholm Region diagnosed with COVID-19 in March–May 2020. The main exposure was any AC treatment. Exposed (n = 91), 49% prevalent (pre-COVID-19 diagnosis) AC and 51% incident AC were compared with unexposed controls (n = 91). The outcome was 28-days all-cause mortality after COVID-19 infection. The mortality odds ratios (OR) were assessed using logistic regression, adjusted for age, sex, multimorbidity, and mobility, also stratified by incident or prevalent AC-type, age group, and sex. Results: Of the 182 individuals diagnosed with COVID-19 (median age 88 years, 68% women), 39% died within 28 days after diagnosis. Use of either incident or prevalent AC was associated with a reduced, adjusted 28-day mortality (OR[95% CI]: 0.31[0.16–0.62]). In stratified analyses, the association was significant in both age groups: 70–89 (OR: 0.37 [0.15–0.89]) and 90–99 years of age (OR: 0.22 [0.07–0.65]. In sex-stratified analysis, the AC-lowering effect was significant in women only (OR: 0.28[0.11–0.67]). In the analyses stratified by AC type, the mortality-lowering effect was observed for both prevalent AC (OR: 0.35[0.12–0.99]) and incident AC (OR: 0.29[0.11–0.76]). Conclusions: Both prevalent and incident use of ACs in prophylactic dosing was associated with reduced 28-day mortality among older individuals with COVID-19 in a NH setting. The effect was seen across age-strata and in women. The findings present new insight in best practice for individuals diagnosed with COVID-19 in the NH setting.

Alkuperäiskieli	Englanti
Artikkeli	e1692
Sivumäärä	9
Julkaisu	Health Science Reports
Vuosikerta	6
Numero	11
DOI - pysyväislinkit	https://doi.org/10.1002/hsr2.1692
Tila	Julkaistu - marrask. 2023
OKM-julkaisutyyppi	A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä

Rahoitus

The following funding is acknowledged in enabling this study: Yrjö Jahnsson Foundation (grant no 20217416), Juho Vainio Foundation (grant number 202100335), Päivikki and Sakari Sohlberg Foundation (grant number 220032), Tampere Tuberculosis Foundation and the Academy of Finland through its funding to the Development of electronic frailty index for Finnish healthcare system (FINeFI, 349335) and Centre of Excellence in Research of Ageing and Care (CoEAgeCare, grant numbers 335870, 326567 and 336670). Swedish Research Council grants (2016‐02317, 2018–02077, 2020‐06101[WISER], 2020‐02014, 2022‐01428), the regional agreement on medical training and clinical research between the Stockholm county council and the Karolinska Institutet (ALF), The Strategic Research Area in Epidemiology and Biostatistics grant, King Gustaf V and Queen Victoria's Foundation of Freemasons. The funders had no role in the design of this study, its execution, analyses, interpretation of the data, or decision to submit results.

Rahoittajat	Rahoittajan numero
AoF Centre of Excellence in Research on Ageing and Care - Ikääntymisen ja hoivan tutkimuksen huippuyksikkö	335870, 336670, 326567
Strategic Research Area in Epidemiology and Biostatistics
Yrjö Jahnssonin säätiö	20217416
Academy of Finland	349335
Juho Vainion Säätiö	202100335
Karolinska Institutet
Päivikki ja Sakari Sohlbergin Säätiö	220032
Vetenskapsrådet	02077, 2020‐06101, 2022‐01428, 2020‐02014, 2016‐02317
Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse
Tampereen tuberkuloosisäätiö

Julkaisufoorumi-taso

Jufo-taso 1

!!ASJC Scopus subject areas

Yleinen lääketiede

Pääsy asiakirjaan

10.1002/hsr2.1692Lisenssi: CC BY-NC-ND

Health Science Reports - 2023 - Kananen - Anticoagulant treatment and COVID‐19 mortality among older adults living in-1Final published version, 1,13 MBLisenssi: CC BY-NC-ND

https://urn.fi/URN:NBN:fi:tuni-2023121510871Lisenssi: CC BY-NC-ND

Siteeraa tätä

@article{7524f5dffb2e444587a7d5f53eb252f6,

title = "Anticoagulant treatment and COVID-19 mortality among older adults living in nursing homes in Sweden",

abstract = "Background: Anticoagulants (AC) were introduced in March 2020 as standard of care in nursing home (NH) residents affected with COVID-19 in the Stockholm region, Sweden. ACs are proven to reduce the risk of complications and mortality from COVID-19 among patients of other ages and settings, but there is limited scientific evidence underpinning this practice in the NH setting. Methods: This matched cohort study included 182 NH residents in the Stockholm Region diagnosed with COVID-19 in March{\textendash}May 2020. The main exposure was any AC treatment. Exposed (n = 91), 49\% prevalent (pre-COVID-19 diagnosis) AC and 51\% incident AC were compared with unexposed controls (n = 91). The outcome was 28-days all-cause mortality after COVID-19 infection. The mortality odds ratios (OR) were assessed using logistic regression, adjusted for age, sex, multimorbidity, and mobility, also stratified by incident or prevalent AC-type, age group, and sex. Results: Of the 182 individuals diagnosed with COVID-19 (median age 88 years, 68\% women), 39\% died within 28 days after diagnosis. Use of either incident or prevalent AC was associated with a reduced, adjusted 28-day mortality (OR[95\% CI]: 0.31[0.16{\textendash}0.62]). In stratified analyses, the association was significant in both age groups: 70{\textendash}89 (OR: 0.37 [0.15{\textendash}0.89]) and 90{\textendash}99 years of age (OR: 0.22 [0.07{\textendash}0.65]. In sex-stratified analysis, the AC-lowering effect was significant in women only (OR: 0.28[0.11{\textendash}0.67]). In the analyses stratified by AC type, the mortality-lowering effect was observed for both prevalent AC (OR: 0.35[0.12{\textendash}0.99]) and incident AC (OR: 0.29[0.11{\textendash}0.76]). Conclusions: Both prevalent and incident use of ACs in prophylactic dosing was associated with reduced 28-day mortality among older individuals with COVID-19 in a NH setting. The effect was seen across age-strata and in women. The findings present new insight in best practice for individuals diagnosed with COVID-19 in the NH setting.",

keywords = "anticoagulants, cohort studies, COVID-19, mortality, nursing home, treatment outcome",

author = "Laura Kananen and Christian Moln{\'a}r and Fredrik Ansker and Kozlowska, \{Daria Julianna\} and Sara H{\"a}gg and Juulia Jylh{\"a}v{\"a} and Dorota Religa and Pauline Raaschou",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.",

year = "2023",

month = nov,

doi = "10.1002/hsr2.1692",

language = "English",

volume = "6",

journal = "Health Science Reports",

issn = "2398-8835",

publisher = "John Wiley \& Sons",

number = "11",

}

TY - JOUR

T1 - Anticoagulant treatment and COVID-19 mortality among older adults living in nursing homes in Sweden

AU - Kananen, Laura

AU - Molnár, Christian

AU - Ansker, Fredrik

AU - Kozlowska, Daria Julianna

AU - Hägg, Sara

AU - Jylhävä, Juulia

AU - Religa, Dorota

AU - Raaschou, Pauline

PY - 2023/11

Y1 - 2023/11

N2 - Background: Anticoagulants (AC) were introduced in March 2020 as standard of care in nursing home (NH) residents affected with COVID-19 in the Stockholm region, Sweden. ACs are proven to reduce the risk of complications and mortality from COVID-19 among patients of other ages and settings, but there is limited scientific evidence underpinning this practice in the NH setting. Methods: This matched cohort study included 182 NH residents in the Stockholm Region diagnosed with COVID-19 in March–May 2020. The main exposure was any AC treatment. Exposed (n = 91), 49% prevalent (pre-COVID-19 diagnosis) AC and 51% incident AC were compared with unexposed controls (n = 91). The outcome was 28-days all-cause mortality after COVID-19 infection. The mortality odds ratios (OR) were assessed using logistic regression, adjusted for age, sex, multimorbidity, and mobility, also stratified by incident or prevalent AC-type, age group, and sex. Results: Of the 182 individuals diagnosed with COVID-19 (median age 88 years, 68% women), 39% died within 28 days after diagnosis. Use of either incident or prevalent AC was associated with a reduced, adjusted 28-day mortality (OR[95% CI]: 0.31[0.16–0.62]). In stratified analyses, the association was significant in both age groups: 70–89 (OR: 0.37 [0.15–0.89]) and 90–99 years of age (OR: 0.22 [0.07–0.65]. In sex-stratified analysis, the AC-lowering effect was significant in women only (OR: 0.28[0.11–0.67]). In the analyses stratified by AC type, the mortality-lowering effect was observed for both prevalent AC (OR: 0.35[0.12–0.99]) and incident AC (OR: 0.29[0.11–0.76]). Conclusions: Both prevalent and incident use of ACs in prophylactic dosing was associated with reduced 28-day mortality among older individuals with COVID-19 in a NH setting. The effect was seen across age-strata and in women. The findings present new insight in best practice for individuals diagnosed with COVID-19 in the NH setting.

AB - Background: Anticoagulants (AC) were introduced in March 2020 as standard of care in nursing home (NH) residents affected with COVID-19 in the Stockholm region, Sweden. ACs are proven to reduce the risk of complications and mortality from COVID-19 among patients of other ages and settings, but there is limited scientific evidence underpinning this practice in the NH setting. Methods: This matched cohort study included 182 NH residents in the Stockholm Region diagnosed with COVID-19 in March–May 2020. The main exposure was any AC treatment. Exposed (n = 91), 49% prevalent (pre-COVID-19 diagnosis) AC and 51% incident AC were compared with unexposed controls (n = 91). The outcome was 28-days all-cause mortality after COVID-19 infection. The mortality odds ratios (OR) were assessed using logistic regression, adjusted for age, sex, multimorbidity, and mobility, also stratified by incident or prevalent AC-type, age group, and sex. Results: Of the 182 individuals diagnosed with COVID-19 (median age 88 years, 68% women), 39% died within 28 days after diagnosis. Use of either incident or prevalent AC was associated with a reduced, adjusted 28-day mortality (OR[95% CI]: 0.31[0.16–0.62]). In stratified analyses, the association was significant in both age groups: 70–89 (OR: 0.37 [0.15–0.89]) and 90–99 years of age (OR: 0.22 [0.07–0.65]. In sex-stratified analysis, the AC-lowering effect was significant in women only (OR: 0.28[0.11–0.67]). In the analyses stratified by AC type, the mortality-lowering effect was observed for both prevalent AC (OR: 0.35[0.12–0.99]) and incident AC (OR: 0.29[0.11–0.76]). Conclusions: Both prevalent and incident use of ACs in prophylactic dosing was associated with reduced 28-day mortality among older individuals with COVID-19 in a NH setting. The effect was seen across age-strata and in women. The findings present new insight in best practice for individuals diagnosed with COVID-19 in the NH setting.

KW - anticoagulants

KW - cohort studies

KW - COVID-19

KW - mortality

KW - nursing home

KW - treatment outcome

U2 - 10.1002/hsr2.1692

DO - 10.1002/hsr2.1692

M3 - Article

AN - SCOPUS:85176604618

SN - 2398-8835

VL - 6

JO - Health Science Reports

JF - Health Science Reports

IS - 11

M1 - e1692

ER -

Anticoagulant treatment and COVID-19 mortality among older adults living in nursing homes in Sweden

Abstrakti

Rahoitus

Julkaisufoorumi-taso

!!ASJC Scopus subject areas

Pääsy asiakirjaan

Sormenjälki

Siteeraa tätä