IN-HOSPITAL MORTALITY rates for pneumonia and COPD decreased after the rollout of Covid-19 vaccines, according to an audit of clinical deaths in 2021.

Pneumonia and COPD (chronic obstructive pulmonary disease) were among the six medical conditions examined for the seventh report of the National Audit of Hospital Mortality (NAHM).

It also looked at acute myocardial infarction (AMI) or heart attack, heart failure, ischaemic stroke and haemorrhagic stroke.

The mortality data in the report is categorised under the six principal diagnoses but this does not necessarily reflect the cause of death in each case.

The report found crude in-hospital mortality for AMI has declined steadily from 69 deaths per 1,000 admissions in 2012 to 48 per 1,000 in 2021.

Crude in-hospital mortality for heart failure increased by 15% between 2020 and 2021, from 63 per 1,000 admissions to 73 per 1,000.

The National Office of Clinical Audit (Noca) said the reasons for the increase in heart failure are not yet evident.

There was a significant reduction (42%) in crude in-hospital mortality for ischaemic stroke from 116 deaths per 1,000 admissions in 2012 to 68 per 1,000 in 2021.

For haemorrhagic stroke, there was a 21% reduction from 309 deaths per 1,000 admissions to 253 per 1,000.

The figure for COPD shows a slight increase from 38 deaths per 1,000 admissions to 41 per 1,000.

This may reflect more severe exacerbations in those with Covid-19 as 13% of the COPD deaths had a recorded Covid-19 flag associated with them.

Pneumonia saw a statistically significant increase from 103 deaths per 1,000 in 2019 to 140 per 1,000 in 2021.

Noca said a rise in the rates for COPD and pneumonia could be directly linked to Covid-19.

However, the rate for the respiratory-related conditions decreased in late 2021 and early 2022 after the vaccination rollout and despite the high number of Covid-19 cases at that time, which Noca said showed the impact of the vaccination programme.

Noca also used the publication of the report to call for clearer documentation in the medical record to ensure accuracy of principal diagnosis.

It said there was a need for an agreed terminology in medical records in the absence of the wording “palliative care” to ensure that all such instances and end-of-life care cases are correctly assigned for inclusion.