lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Cardiovascular Therapy and Mortality in Hospitalized Patients With COVID-19: A Cohort Study

23 Pages Posted: 28 Jun 2021

See all articles by Cédric Follonier

Cédric Follonier

University of Geneva - Geneva University Hospitals

Elena Tessitore

University of Geneva - Geneva University Hospitals

Sandra Handgraaf

University of Geneva - Geneva University Hospitals

David Carballo

University of Geneva - Geneva University Hospitals

Maëlle Achard

University of Geneva - Geneva University Hospitals

Antoinette Pechère-Bertschi

University of Geneva

François Mach

University of Geneva - Geneva University Hospitals

François R. Herrmann

University of Geneva

François R. Girardin

University of Lausanne - Division of Clinical Pharmacology; University of Geneva - Division of Clinical Pharmacology and Toxicology

More...

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 infection has a significant impact on the cardiovascular system and drugs acting on the latter are suspected to influence clinical outcome. This study aims to assess cardiovascular therapy exposure status (i.e. absence, continuation, discontinuation, and initiation) relative to admission and in-hospital mortality among inpatients with COVID-19. 

Methods: A retrospective cohort study including all hospitalized adult patients with confirmed COVID-19 at the Geneva University Hospitals from February 26, 2020, and discharged by June 5, 2020 was conducted. A twostep multivariate logistic regression adjusted for potential confounding factors was used to quantify the associations between mortality and exposure status to eight main cardiovascular drug categories. 

Findings: Of 838 inpatients with COVID-19, 781 (93·2%) received cardiovascular drugs, and 152 (18·1%) died before discharge. Drug exposures associated with decreased in-hospital mortality were renin-angiotensin system inhibitor continuation (adjusted odds ratio (aOR) 0·51 [0·28-0·94], p=0·031) and initiation (aOR 0·06 [0·01-0·42], p=0·005), and lipid-modifying agent continuation (aOR 0·52 [0·27-0·99], p=0·046). Exposures associated with increased in-hospital mortality were discontinuation of renin-angiotensin system inhibitors (aOR 2·34 [1·07-5·12],   p=0·033), lipid-modifying agents (aOR 3·25 [1·31-8·07], p=0·011), and anticoagulants (aOR 14·93 [2·24-99·41], p=0·005). Diuretic continuation (aOR 2·09 [1·07-4·08], p=0·031) and initiation (aOR 6·20 [3·38-11·39], p<0·001), and antiarrhythmic initiation (aOR 5·49 [1·40-21·61], p=0·015) were associated with increased mortality. 

Interpretation: In hospitalized patients with COVID-19, the use continuation of cardiovascular drugs, except diuretics, appeared safe and should be continued. The use of renin-angiotensin system inhibitor and lipid-modifying agents was associated with lower in-hospital mortality.  

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Declaration of Interests: None declared.

Ethics Approval Statement: The study protocol was evaluated and accepted by the Geneva Research Ethics Committee (protocol 2020-00610) with a waiver of ad hoc informed consent.

Suggested Citation

Follonier, Cédric and Tessitore, Elena and Handgraaf, Sandra and Carballo, David and Achard, Maëlle and Pechère-Bertschi, Antoinette and Mach, François and Herrmann, François R. and Girardin, François R., Cardiovascular Therapy and Mortality in Hospitalized Patients With COVID-19: A Cohort Study. Available at SSRN: https://ssrn.com/abstract=3875394 or http://dx.doi.org/10.2139/ssrn.3875394

Cédric Follonier

University of Geneva - Geneva University Hospitals ( email )

Geneva, CH-1211
Switzerland

Elena Tessitore

University of Geneva - Geneva University Hospitals ( email )

Geneva, CH-1211
Switzerland

Sandra Handgraaf

University of Geneva - Geneva University Hospitals ( email )

Geneva, CH-1211
Switzerland

David Carballo

University of Geneva - Geneva University Hospitals ( email )

Geneva, CH-1211
Switzerland

Maëlle Achard

University of Geneva - Geneva University Hospitals ( email )

Geneva, CH-1211
Switzerland

Antoinette Pechère-Bertschi

University of Geneva ( email )

102 Bd Carl-Vogt
Genève, CH - 1205
Switzerland

François Mach

University of Geneva - Geneva University Hospitals ( email )

Geneva, CH-1211
Switzerland

François R. Herrmann

University of Geneva ( email )

102 Bd Carl-Vogt
Genève, CH - 1205
Switzerland

François R. Girardin (Contact Author)

University of Lausanne - Division of Clinical Pharmacology ( email )

Rue du Bugnon 17
Lausanne
Switzerland
+41 22 314 42 76 (Phone)
+41 22 314 42 66 (Fax)

University of Geneva - Division of Clinical Pharmacology and Toxicology

Geneva
Switzerland