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

Philip Braude; Ben Carter; Roxanna Short; Arturo Vilches-Moraga; Alessia Verduri; Miss Lyndsay Pearce; Miss Angeline Price; Terence J Quinn; Michael Stechman; Jemima Collins; Eilidh Bruce; Alice Einarsson; Frances Rickard; Emma Mitchell; Mark Holloway; James Hesford; Fenella Barlow-Pay; Enrico Clini; Phyo Kyaw Myint; Susan Moug; Kathryn McCarthy; Jonathan Hewitt

doi:10.1016/j.ijcha.2020.100660

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

Philip Braude, Ben Carter, Roxanna Short, Arturo Vilches-Moraga, Alessia Verduri, Miss Lyndsay Pearce, Miss Angeline Price, Terence J Quinn, Michael Stechman, Jemima Collins, Eilidh Bruce, Alice Einarsson, Frances Rickard, Emma Mitchell, Mark Holloway, James Hesford, Fenella Barlow-Pay, Enrico Clini, Phyo Kyaw Myint, Susan MougKathryn McCarthy, Jonathan Hewitt

Research output: Contribution to journal › Article › peer-review

22 Citations (Scopus)

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.

Original language	English
Article number	100660
Number of pages	7
Journal	IJC Heart & Vasculature
Volume	31
Early online date	15 Oct 2020
DOIs	https://doi.org/10.1016/j.ijcha.2020.100660
Publication status	Published - 1 Dec 2020

Keywords

Coronavirus
Angiotensin receptor antagonists
angiotensin-converting enzyme inhibitors
hospitalization
hospital mortality
Angiotensin-converting enzyme inhibitors
Hospital mortality
Hospitalization

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Braude, P., Carter, B., Short, R., Vilches-Moraga, A., Verduri, A., Lyndsay Pearce, M., Angeline Price, M., Quinn, T. J., Stechman, M., Collins, J., Bruce, E., Einarsson, A., Rickard, F., Mitchell, E., Holloway, M., Hesford, J., Barlow-Pay, F., Clini, E., Kyaw Myint, P., ... Hewitt, J. (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]. https://doi.org/10.1016/j.ijcha.2020.100660

Braude, P, Carter, B, Short, R, Vilches-Moraga, A, Verduri, A, Lyndsay Pearce, M, Angeline Price, M, Quinn, TJ, Stechman, M, Collins, J, Bruce, E, Einarsson, A, Rickard, F, Mitchell, E, Holloway, M, Hesford, J, Barlow-Pay, F, Clini, E, Kyaw Myint, P, Moug, S, McCarthy, K & Hewitt, J 2020, 'The influence of ACE inhibitors and ARBs on hospital length of stay and survival in people with COVID-19', IJC Heart & Vasculature, vol. 31, 100660. https://doi.org/10.1016/j.ijcha.2020.100660

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

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.",

keywords = "Coronavirus, Angiotensin receptor antagonists, angiotensin-converting enzyme inhibitors, hospitalization, hospital mortality, Angiotensin-converting enzyme inhibitors, Hospital mortality, Hospitalization",

author = "Philip Braude and Ben Carter and Roxanna Short and Arturo Vilches-Moraga and Alessia Verduri and {Lyndsay Pearce}, Miss and {Angeline Price}, Miss and Quinn, {Terence J} and Michael Stechman and Jemima Collins and Eilidh Bruce and Alice Einarsson and Frances Rickard and Emma Mitchell and Mark Holloway and James Hesford and Fenella Barlow-Pay and Enrico Clini and {Kyaw Myint}, Phyo and Susan Moug and Kathryn McCarthy and Jonathan Hewitt",

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AU - Braude, Philip

AU - Carter, Ben

AU - Short, Roxanna

AU - Vilches-Moraga, Arturo

AU - Verduri, Alessia

AU - Lyndsay Pearce, Miss

AU - Angeline Price, Miss

AU - Quinn, Terence J

AU - Stechman, Michael

AU - Collins, Jemima

AU - Bruce, Eilidh

AU - Einarsson, Alice

AU - Rickard, Frances

AU - Mitchell, Emma

AU - Holloway, Mark

AU - Hesford, James

AU - Barlow-Pay, Fenella

AU - Clini, Enrico

AU - Kyaw Myint, Phyo

AU - Moug, Susan

AU - McCarthy, Kathryn

AU - Hewitt, Jonathan

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N2 - 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.

AB - 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.

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KW - Angiotensin receptor antagonists

KW - angiotensin-converting enzyme inhibitors

KW - hospitalization

KW - hospital mortality

KW - Angiotensin-converting enzyme inhibitors

KW - Hospital mortality

KW - Hospitalization

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

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Keywords

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