Journal Article

Cardiovascular therapy use, modification, and in-hospital death in patients with COVID-19: A cohort study

Herrmann, François R., Handgraaf, Sandra, Mach, François, Pechère-Bertschi, Antoinette, Tessitore, Elena, Carballo, David, Follonier, Cédric, Achard, Maëlle, Girardin, François R.

2022

Overview

To assess the associations of exposure and modifications in exposure (i.e., discontinuation on admission, initiation during hospitalization) to eight common cardiovascular therapies with the risk of in-hospital death among inpatients with coronavirus disease 2019 (COVID-19). In this observational study including 838 hospitalized unvaccinated adult patients with confirmed COVID-19, the use of cardiovascular therapies was assessed using logistic regression models adjusted for potential confounders. No cardiovascular therapy used before hospitalization was associated with an increased risk of in-hospital death. During hospitalization, the use of diuretics (aOR 2.59 [1.68-3.98]) was associated with an increase, and the use of agents acting on the renin-angiotensin system (aOR 0.39 [0.23-0.64]) and lipid-lowering agents (aOR 0.41 [0.24-0.68]) was associated with a reduction in the odds of in-hospital death. Exposure modifications associated with decreased survival were the discontinuation of an agent acting on the renin-angiotensin system (aOR 4.42 [2.08-9.37]), a β-blocker (aOR 5.44 [1.16-25.46]), a lipid-modifying agent (aOR 3.26 [1.42-7.50]) or an anticoagulant (aOR 5.85 [1.25-27.27]), as well as the initiation of a diuretic (aOR 5.19 [2.98-9.03]) or an antiarrhythmic (aOR 6.62 [2.07-21.15]). Exposure modification associated with improved survival was the initiation of an agent acting on the renin-angiotensin system (aOR 0.17 [0.03-0.82]). In hospitalized and unvaccinated patients with COVID-19, there was no detrimental association of the prehospital use of any regular cardiovascular medication with in-hospital death, and these therapies should be continued as recommended.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: ACE inhibitors / Acute coronary syndromes / Adult / Angiotensin / Anticoagulants / Antilipemic agents / Biology and Life Sciences / Cardiac arrhythmia / Cardiovascular disease / Cardiovascular diseases / Cohort analysis / Cohort Studies / Coronaviruses / COVID-19 / COVID-19 Drug Treatment / Death / Diabetes / Diuretics / Diuretics - therapeutic use / Dosage and administration / Endocrine system / Exposure / Health risks / Heart failure / Hospital care / Hospital Mortality / Hospitalization / Hospitals / Humans / Infections / Ischemia / Lipids / Liver diseases / Medical records / Medicine and Health Sciences / Methods / Mortality / Observational studies / Patient outcomes / Patients / Regression analysis / Regression models / Renin / Respiratory diseases / Risk factors / Severe acute respiratory syndrome coronavirus 2 / Survival / Variables / Viral diseases