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ABSTRACT: Objective
During the COVID-19 pandemic the continuation or cessation of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) has been contentious. Mechanisms have been proposed for both beneficial and detrimental effects. Recent studies have focused on mortality with no literature having examined length of hospital stay. The aim of this study was to determine the influence of ACEi and ARBs on COVID-19 mortality and length of hospital stay.Methods
COPE (COVID-19 in Older People) is a multicenter observational study including adults of all ages admitted with either laboratory or clinically confirmed COVID-19. Routinely generated hospital data were collected. Primary outcome: mortality; secondary outcomes: Day-7 mortality and length of hospital stay. A mixed-effects multivariable Cox's proportional baseline hazards model and logistic equivalent were used.Results
1371 patients were included from eleven centres between 27th February to 25th April 2020. Median age was 74 years [IQR 61-83]. 28.6% of patients were taking an ACEi or ARB. There was no effect of ACEi or ARB on inpatient mortality (aHR = 0.85, 95%CI 0.65-1.11). For those prescribed an ACEi or ARB, hospital stay was significantly reduced (aHR = 1.25, 95%CI 1.02-1.54, p = 0.03) and in those with hypertension the effect was stronger (aHR = 1.39, 95%CI 1.09-1.77, p = 0.007).Conclusions
Patients and clinicians can be reassured that prescription of an ACEi or ARB at the time of COVID-19 diagnosis is not harmful. The benefit of prescription of an ACEi or ARB in reducing hospital stay is a new finding.
SUBMITTER: Braude P
PROVIDER: S-EPMC7561344 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
Braude Philip P Carter Ben B Short Roxanna R Vilches-Moraga Arturo A Verduri Alessia A Pearce Lyndsay L Price Angeline A Quinn Terence J TJ Stechman Michael M Collins Jemima J Bruce Eilidh E Einarsson Alice A Rickard Frances F Mitchell Emma E Holloway Mark M Hesford James J Barlow-Pay Fenella F Clini Enrico E Myint Phyo Kyaw PK Moug Susan S McCarthy Kathryn K Hewitt Jonathan J
International journal of cardiology. Heart & vasculature 20201015
<h4>Objective</h4>During the COVID-19 pandemic the continuation or cessation of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) has been contentious. Mechanisms have been proposed for both beneficial and detrimental effects. Recent studies have focused on mortality with no literature having examined length of hospital stay. The aim of this study was to determine the influence of ACEi and ARBs on COVID-19 mortality and length of hospital stay.<h4>Methods</ ...[more]