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).
ABSTRACT
Since the onset of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, various potential targeted therapies for SARS-CoV-2 infection have been proposed. The protective effects of mineralocorticoid receptor antagonists (MRA) against tissue fibrosis, pulmonary and systemic vasoconstriction, and inflammation have been implicated in potentially attenuating the severity of SARS-CoV-2 infection by inhibiting the deleterious effects of aldosterone. Furthermore, spironolactone, a type of MRA, has been suggested to have a beneficial effect on SARS-CoV-2 outcomes through its dual action as an MRA and antiandrogen, resulting in reduced transmembrane protease receptor serine type 2 (TMPRSS2)-related viral entry to host cells. In this study, we sought to investigate the association between MRA antagonist therapy and mortality in SARS-CoV-2 patients via systematic review and meta-analysis. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE and EMBASE databases were searched for studies that reported the incidence of mortality in patients on MRA with SARS-CoV-2 infection. Pooled odds ratio (OR) and 95% confidence interval (CI) of the outcome were obtained using the random-effects model. Five studies with a total of 1,388,178 subjects (80,903 subjects receiving MRA therapy) met the inclusion criteria. We included studies with all types of MRA therapy including spironolactone and canrenone and found no association between MRA therapy and mortality in SARS-CoV-2 infection (OR = 0.387, 95% CI: 0.134-1.117, p = 0.079).
ABSTRACT
Introduction: COVID-19's impact on in-hospital care quality and outcomes of patients hospitalized with acute heart failure (HF) has not been systematically evaluated nationally. Methods: Patients hospitalized with HF with ejection fraction (EF) <40% in the AHA GWTG-HF registry during the pandemic (3/1/2020 - 4/1/ 2021) and pre-pandemic (2/1/2019 - 2/29/2020) periods were included. Adherence to HF process of care measures, in-hospital mortality, and length of stay (LOS) were compared in the pre-pandemic vs pandemic period and among hospitalized HF patients with vs without COVID-19 across both periods. Results: 40,005 pre-pandemic and 35,561 pandemic period patients admitted across 346 centers (median age 68, 33% women, 58% White) were included. There were no differences in clinical characteristics, comorbidities, presentation vital signs, or EF during the pandemic vs pre-pandemic periods. Among process of care measures, utilization of guideline-directed medical therapy at discharge was comparable across both periods. In contrast, rates of ICD placement or prescription and blood pressure control at discharge were lower during the pandemic (vs pre-pandemic period) (Table). In-hospital death (2.5% vs. 3.0%, p<0.001) and LOS (mean 5.4 vs. 5.7 days, p=0.008) were higher during the pandemic vs pre-pandemic. Substantial geographic variation was seen in the inhospital death rates during the pandemic, with highest rates among patients hospitalized in the Northeast region (3.36%). Among HF patients hospitalized during the pandemic with COVID-19 (N = 527 [1.5%]), adherence to ICD placement or prescription at discharge and prescription of aldosterone antagonist or ACE/ARB/ARNi were lower, and risk of in-hospital death and length of stay were significantly higher than those without COVID-19. Conclusion: In-hospital mortality and adherence to certain quality measures worsened during COVID-19 pandemic among patients admitted for acute decompensated HFrEF.