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.