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

Braude, Philip, Carter, Ben, Short, Roxanna, Vilches-Moraga, Arturo, Verduri, Alessia, Pearce, Lyndsay, Price, Angeline, Quinn, Terence J., Stechman, Michael, Collins, Jemima, Bruce, Eilidh, Einarsson, Alice, Rickard, Frances, Mitchell, Emma, Holloway, Mark, Hesford, James, Barlow-Pay, Fenella, Clini, Enrico, Myint, Phyo Kyaw, Moug, Susan, McCarthy, Kathryn and Hewitt, Jonathan 2020. The influence of ACE inhibitors and ARBs on hospital length of stay and survival in people with COVID-19. IJC Heart & Vasculature 31 , 100660. 10.1016/j.ijcha.2020.100660

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Abstract

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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ISSN: 2352-9067
Date of First Compliant Deposit: 19 May 2021
Date of Acceptance: 8 October 2020
Last Modified: 21 May 2021 10:45
URI: http://orca.cardiff.ac.uk/id/eprint/141464

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