The influence of ACE inhibitors and ARBs on hospital length of stay and survival in people with COVID-19

International Journal of Cardiology: Heart & Vasculature

Jonathan Hewitt¹  Philip Braude²  Kathryn McCarthy³  Mark Holloway³  Frances Rickard³  Emma Mitchell³  James Hesford³  Angeline Price⁴  Arturo Vilches-Moraga⁴  Ben Carter⁵  Roxanna Short⁶  Phyo Kyaw Myint⁷  Eilidh Bruce⁸  Susan Moug⁹  Fenella Barlow-Pay^1,10  Lyndsay Pearce^1,11  Michael Stechman^1,12  Terence J. Quinn^1,13  Alessia Verduri^1,14  Enrico Clini^1,14  Alice Einarsson^1,15  Jemima Collins^1,16 

[1] Cardiff University and Honorary Consultant Physician, Aneurin Bevan University Health Board, UK;Department for Medicine for Older People, North Bristol NHS Trust, Bristol, UK;Department for Medicine for Older People, North Bristol NHS Trust, UK;Department of Ageing and Complex Medicine, Salford Royal Hospital, UK;Department of Biostatistics and Health Informatics, King’s College London, UK;King’s College London, UK;Medicine of Old Age, University of Aberdeen, UK;NHS Grampian, UK;Royal Alexandra Hospital Paisley and Honorary Professor of Surgery, University of Glasgow, UK;Royal Alexandra Hospital, Paisley, Canada;Salford Royal Hospital, UK;University Hospital of Wales, UK;University of Glasgow and Honorary Consultant Physician, Glasgow Royal Infirmary, UK;University of Modena and Reggio Emilia, Hospital Policlinico Modena, Italy;Woodend Hospital, Aberdeen, UK;Ystbty Ystard Fawr, UK;

关键词: Coronavirus;    Angiotensin receptor antagonists;    Angiotensin-converting enzyme inhibitors;    Hospitalization;    Hospital mortality;   

DOI  :  

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown