ABSTRACT
Introduction: Although the effects of SARS-CoV-2 infection on the cardiovascular system are well known in the acute phase, the cardiovascular impact in the elderly population surviving respiratory COVID-19 infection after 1-year follow-up has not been sufficiently studied. Methods: Observational registry of 240 elderly patients (75 years or older) consecutively admitted for and surviving COVID-19 respiratory infection between March 1 and April 30, 2020. The incidence of major cardiovascular events [MACE] (cardiovascular death [CD], acute coronary syndrome [ACS], cerebrovascular disease [CVD], venous thromboembolic disease [VTE], and heart failure [HF]) was prospectively analyzed. Results: The mean age was 83.8 ± 5.6 years (range 75-103 years). A total of 54.2% were women. Most patients had a personal history of cardiovascular risk factors: hypertension (83.3%), diabetes mellitus (27.9%), dyslipidemia (43.8%). Among the main cardiological comorbidities, a history of atrial fibrillation was the most frequent (18.8%). Of note was the high percentage of institutionalized patients (37.1%) and those with moderate-severe dementia (16.7%). After a mean follow-up of 352.2±70.4 days, 13.8% of patients died and 9.6% had MACE, the most frequent being heart failure (7.5%), with no differences in the severity or overall evolution of the acute disease. Of the 33 patients who developed HF, only 3 died of cardiovascular causes. Only 2 patients suffered a stroke, in both cases without a history of AF or anticoagulants. Only 2 patients had a thromboembolic event (0.8%). The low incidence of thrombotic events may be due in part to the high rate of anticoagulation and chronic antiplatelet therapy and the high percentage of prophylactic heparin prescription at discharge, as well as the fact that only cases with clinical repercussions. COPD, CKD, institutionalization and moderate-severe dementia are associated with an increased risk of MACE, although only COPD and prescription of loop diuretics were identified as independent risk markers in the multivariate analysis. Conclusions: In elderly COVID-19 survivors, the incidence of MACE after one year of follow-up is high, the main manifestation being heart failure. COPD and the prescription of loop diuretics were identified as independent risk markers for the development of MACE in the multivariate analysis. Baseline clinical characteristics Cox survival analysis.Predictors of MACE.
ABSTRACT
Introduction: The management of antihypertensive drugs and especially ACEI/ARA2 during the first wave of the SARS-CoV-2 pandemic was a matter of debate. The change in antihypertensive treatment during the pandemic and its repercussions have not been sufficiently studied. Methods: Observational and prospective study that analyzed consecutive patients admitted for respiratory infection and positive polymerase chain reaction (PCR) between March 1 and April 30, 2020. During the period analyzed, 921 patients were registered, of whom 673 patients were discharged;among them 359 were patients with a diagnosis of arterial hypertension and pharmacological treatment. These patients were followed up in days, from the time of discharge to data analysis, with a mean of 352±70.4 days. Results: The mean age was 74.4±12.9 years, and 50.7% were male. A total of 28.7% were diabetic patients, 49% were dyslipidemic, 17.8% were smokers, and 19.8% were obese. Of the patients analyzed, 13.4% had a previous diagnosis of ischemic heart disease, a similar percentage, 13.1% had heart failure, and 13.6% had atrial fibrillation. The antihypertensive drugs analyzed were ACE inhibitors (angiotensin-converting enzyme inhibitors), ARA-2 (angiotensin II receptor antagonists), calcium antagonists, thiazide diuretics, loop diuretics, aldosterone antagonists, beta-blockers and alpha-blockers. At discharge, 75.8% of the patients maintained their antihypertensive treatment, and the remaining 24.2% were modified. Prior to admission, 77.2% were taking ACE inhibitors or ARA-2;however, in 16.4% of the patients they were discontinued after admission. In contrast, treatment with calcium antagonists increased from 27.6% to 34.1% after hospitalization. In both cases there were statistically significant differences in the bivariate analysis in the McNemar test (p < 0.05 in both cases), with no differences in the other antihypertensive drugs analyzed. After follow-up, the combined event occurred in 28 patients, with the most frequent event being the development of HF;in contrast, only 0.8% presented ACS. Overall mortality was 8.9%. Picture 1 shows the events recorded according to the change in antihypertensive treatment and the maintenance or discontinuation of ACEI/ARA-2 in those patients who were already taking it on admission. Similarly, a survival analysis was performed in which no differences were observed in terms of all-cause mortality or major cardiovascular events between patients who maintained their antihypertensive treatment and those who modified it. Conclusions: In the population surviving SARS-CoV-2 respiratory infection, maintaining or discontinuing treatment with ACEI/ARA-2 did not influence mortality or the appearance of major cardiovascular events after the first year of follow-up. (Table Presented).