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Usefulness of Combined Renin-Angiotensin System Inhibitors and Diuretic Treatment In Patients Hospitalized with COVID-19.

Authors :
Palazzuoli A
Tecson KM
Vicenzi M
D'Ascenzo F
De Ferrari GM
Monticone S
Secco GG
Tavazzi G
Forleo G
Severino P
Fedele F
De Rosa F
McCullough PA
Source :
The American journal of cardiology [Am J Cardiol] 2022 Mar 15; Vol. 167, pp. 133-138. Date of Electronic Publication: 2022 Jan 10.
Publication Year :
2022

Abstract

Antecedent use of renin-angiotensin system inhibitors (RASi) prevents clinical deterioration and protects against cardiovascular/thrombotic complications of COVID-19, for indicated patients. Uncertainty exists regarding treatment continuation throughout infection and doing so with concomitant medications. Hence, the purpose of this study is to evaluate the differential effect of RASi continuation in patients hospitalized with COVID-19 according to diuretic use. We used the Coracle registry, which contains data of hospitalized patients with COVID-19 from 4 regions of Italy. We used Firth logistic regression for adult (>50 years) cases with admission on/after February 22, 2020, with a known discharge status as of April 1, 2020. There were 286 patients in this analysis; 100 patients (35.0%) continued RASi and 186 (65%) discontinued. There were 98 patients treated with a diuretic; 51 (52%) of those continued RASi. The in-hospital mortality rates in patients treated with a diuretic and continued versus discontinued RASi were 8% versus 26% (p = 0.0179). There were 188 patients not treated with a diuretic; 49 (26%) of those continued RASi. The in-hospital mortality rates in patients not treated with a diuretic and continued versus discontinued RASi were 16% versus 9% (p = 0.1827). After accounting for age, cardiovascular disease, and laboratory values, continuing RASi decreased the risk of mortality by approximately 77% (odds ratio 0.23, 95% confidence interval 0.06 to 0.95, p = 0.0419) for patients treated with diuretics, but did not alter the risk in patients treated with RASi alone. Continuing RASi in patients concomitantly treated with diuretics was associated with reduced in-hospital mortality.<br />Competing Interests: Disclosures The authors have no conflicts of interest to declare.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1879-1913
Volume :
167
Database :
MEDLINE
Journal :
The American journal of cardiology
Publication Type :
Academic Journal
Accession number :
35027137
Full Text :
https://doi.org/10.1016/j.amjcard.2021.12.004