COVID-19 In-Hospital Mortality and Use of Renin-Angiotensin System Blockers in Geriatrics Patients.
Bastien Genet, Jean-Sébastien Vidal, Adrien Cohen and 15 others
PMID 33138935WHAT IT FOUND
In 201 very old hospitalized COVID-19 patients, those already taking ACE inhibitors or ARBs had lower 30-day mortality (22.2% vs 37.7%).
This is association only; the study cannot prove the drugs caused benefit.
Key findings
01Of 201 included patients, 66 (33.8%) died within 30 days, and no surviving patient was lost to follow-up.
02Patients already taking ACEI or ARB had lower 30-day mortality than those not taking them: 22.2% versus 37.7%, and the adjusted hazard ratio was 0.52.
03Severe disability was associated with death: ADL score below 2 occurred in 67.7% of nonsurvivors versus 46.7% of survivors, and adjusted hazard ratio was 2.54.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-center retrospective cohort, so it cannot show that ACEI or ARB use caused lower mortality. Dose, indication, duration, and continuation of ACEI/ARB during COVID-19 were not recorded. The study had no sufficient power to analyze ARB and ACEI separately, and neither class was significant after adjustment. Patients receiving ACEI or ARB were not identical: they had more hypertension and coronary artery disease and were more often treated with other cardiovascular drugs. Statin use and several laboratory measures were not recorded or were missing, which could affect mortality. Causes of death were not recorded, and deaths within 30 days were assumed to be related to COVID-19. Diagnosis was based on RT-PCR only, so false-negative infections may have been missed. Only patients assessed as not fit enough for intensive care were included, so findings may not apply to older patients who receive intensive care.
The easy way to misread this
Do not read the lower mortality as proof that ACEI or ARB treatment prevents death. This was an observational cohort, and when ARB and ACEI were analyzed separately after adjustment neither showed a significant effect.