Am Heart J . Renin-Angiotensin system inhibitors effect before and during hospitalization in COVID-19 outcomes: final analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry

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Am Heart J


. 2021 Apr 9;S0002-8703(21)00089-2.
doi: 10.1016/j.ahj.2021.04.001. Online ahead of print.
Renin-Angiotensin system inhibitors effect before and during hospitalization in COVID-19 outcomes: final analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry


Iv?n J N??ez-Gil ¹ , Iv?n Olier ² , Gisela Feltes ³ , Mar?a C Viana-Llamas ⁴ , Charbel Maroun-Eid ⁵ , Rodolfo Romero ⁶ , Inmaculada Fern?ndez-Rozas ⁷ , Aitor Uribarri ⁸ , Victor M Becerra-Mu?oz ⁹ , Emilio Alfonso-Rodriguez ¹⁰ , Marcos Garc?a-Aguado ¹¹ , Javier Elola ¹² , Alex Castro-Mej?a ¹³ , Martino Pepe ¹⁴ , Juan Fortunato Garcia-Prieto ¹⁵ , Adelina Gonzalez ¹⁶ , Fabrizio Ugo ¹⁷ , Enrico Cerrato ¹⁸ , Elvira Bondia ¹⁹ , Sergio Raposeiras ²⁰ , Jorge L Jativa Mendez ²¹ , Carolina Espejo ²² , ?lvaro L?pez Masjuan ²³ , Francisco Marin ²⁴ , Javier L?pez-Pais ²⁵ , Mohammad Abumayyaleh ²⁶ , Miguel Corbi-Pascual ²⁷ , Christoph Liebetrau ²⁸ , Harish Ramakrisna ²⁹ , Vicente Estrada ³⁰ , Carlos Macaya ³⁰ , HOPE COVID-19 investigators (Cols appendix)



Affiliations

• PMID: 33845032
• DOI: 10.1016/j.ahj.2021.04.001

Abstract

Background: The use of Renin-Angiotensin system inhibitors (RASi) in patients with coronavirus disease 2019 (COVID-19) has been questioned because both share a target receptor site.
Methods: HOPE-COVID-19 (NCT04334291) is an international investigator-initiated registry. Patients are eligible when discharged after an in-hospital stay with COVID-19, dead or alive. Here, we analyze the impact of previous and continued in-hospital treatment with RASi in all-cause mortality and the development of in-stay complications.
Results: We included 6503 patients, over 18 years, from Spain and Italy with data on their RASi status. Of those, 36.8% were receiving any RASi before admission. RASi patients were older, more frequently male, with more comorbidities and frailer. Their probability of death and ICU admission was higher. However, after adjustment, these differences disappeared. Regarding RASi in-hospital use, those who continued the treatment were younger, with balanced comorbidities but with less severe COVID19. Raw mortality and secondary events were less frequent in RASi. After adjustment, patients receiving RASi still presented significantly better outcomes, with less mortality, ICU admissions, respiratory insufficiency, need for mechanical ventilation or prone, sepsis, SIRS and renal failure (p<0.05 for all). However, we did not find differences regarding the hospital use of RASi and the development of heart failure.
Conclusion: RASi historic use, at admission, is not related to an adjusted worse prognosis in hospitalized COVID-19 patients, although it points out a high-risk population. In this setting, the in-hospital prescription of RASi is associated with improved survival and fewer short-term complications.

Keywords: ACEI; ARB; COVID-19; RAS; heart disease; mortality; prognosis; registry.