• Rohan Khera, Yusi Liu, James A de Lemos, Sandeep R Das, Ambarish Pandey, Wally Omar, Dharam J Kumbhani, Saket Girotra, Robert W Yeh, Christine Rutan, Jason Walchok, Zhenqiu Lin, Steven M Bradley, Eric J Velazquez, Keith B Churchwell, Brahmajee K Nallamothu, Harlan M Krumholz, and Jeptha P Curtis.
• Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn. Electronic address: rohan.khera@yale.edu.
• Am. J. Med. 2021 Nov 1; 134 (11): 1380-1388.e3.

BackgroundWhether the volume of coronavirus disease 2019 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and future novel and rapidly evolving high-volume conditions.MethodsWe 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 COVID-19 hospitalization volume and weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR).ResultsThere were 85 hospitals with 15,329 COVID-19 hospitalizations, with a median hospital case volume was 118 (interquartile range, 57, 252) and median growth rate of 2 cases per 100 beds per week but varied widely (interquartile range: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = .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 = .03). Although there were no differences in medical treatments or intensive care unit therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (odds ratio, 4.00; 1.15 to 13.8, P = .03).ConclusionsAn 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.Copyright © 2021 Elsevier Inc. All rights reserved.

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