Alexandre Lahens1, Jimmy Mullaert2,3, Simon Gressens4, Nathalie Gault3, Martin Flamant1,5, Laurène Deconinck4, Véronique Joly4, Yazdan Yazdanpanah2,4, François-Xavier Lescure2,4, Emmanuelle Vidal-Petiot1,5. 1. Physiology Department, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital. 2. INSERM, IAME, UMR 1137, Université de Paris. 3. Biostatistics, Epidemiology and Clinical Research Department, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital. 4. Infectious and Tropical Diseases Department, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital. 5. Inserm U1149, Centre for Research on Inflammation, Université de Paris, Paris, France.
Abstract
OBJECTIVE: The role of renin-angiotensin-aldosterone system (RAAS) blockers during the coronavirus disease 2019 (COVID-19) pandemic is a matter of controversies. Studies based on in-hospital exposure have suggested a beneficial effect of these drugs, unlike those based on chronic exposure. We aimed to analyse RAAS blocker prescription before and during hospital stay in patients with COVID-19, and the corresponding outcomes, to explain these discrepant results. METHODS: In a retrospective cohort study conducted in 347 patients hospitalized for COVID-19 (Bichat Hospital, Paris, France, 23 January-29 April 2020), RAAS blocker exposure, as well as timing and reason for treatment modifications, were collected. The association between exposure and mortality within 30 days of hospital admission was analysed using logistic regression analysis adjusted for age, sex, and comorbidities. RESULTS: Median age was 61 [interquartile range, 51-72] years, 209 (60%) were male, 169 (49%) had a history of treated hypertension, and 117 (34%) received a RAAS blocker prior to hospitalization. RAAS blockers were discontinued within the first 7 days of hospital admission in 33% of previously treated patients (mostly driven by severity of the disease), with a corresponding mortality rate of 33%. Mortality was 8% when treatment was maintained or introduced, and 12% in patients never exposed. Adjusted odds ratios for association between exposure and mortality were 0.62 (95% confidence interval 0.25-1.48) based on chronic exposure and 0.25 (0.09-0.65) based on in-hospital exposure. CONCLUSION: A 'healthy user-sick stopper' bias influences RAAS blocker prescription after hospital admission for COVID-19, and explains the seemingly favourable outcome associated with in-hospital treatment.
OBJECTIVE: The role of renin-angiotensin-aldosterone system (RAAS) blockers during the coronavirus disease 2019 (COVID-19) pandemic is a matter of controversies. Studies based on in-hospital exposure have suggested a beneficial effect of these drugs, unlike those based on chronic exposure. We aimed to analyse RAAS blocker prescription before and during hospital stay in patients with COVID-19, and the corresponding outcomes, to explain these discrepant results. METHODS: In a retrospective cohort study conducted in 347 patients hospitalized for COVID-19 (Bichat Hospital, Paris, France, 23 January-29 April 2020), RAAS blocker exposure, as well as timing and reason for treatment modifications, were collected. The association between exposure and mortality within 30 days of hospital admission was analysed using logistic regression analysis adjusted for age, sex, and comorbidities. RESULTS: Median age was 61 [interquartile range, 51-72] years, 209 (60%) were male, 169 (49%) had a history of treated hypertension, and 117 (34%) received a RAAS blocker prior to hospitalization. RAAS blockers were discontinued within the first 7 days of hospital admission in 33% of previously treated patients (mostly driven by severity of the disease), with a corresponding mortality rate of 33%. Mortality was 8% when treatment was maintained or introduced, and 12% in patients never exposed. Adjusted odds ratios for association between exposure and mortality were 0.62 (95% confidence interval 0.25-1.48) based on chronic exposure and 0.25 (0.09-0.65) based on in-hospital exposure. CONCLUSION: A 'healthy user-sick stopper' bias influences RAAS blocker prescription after hospital admission for COVID-19, and explains the seemingly favourable outcome associated with in-hospital treatment.
Authors: Irene Capelli; Francesca Iacovella; Laura Ghedini; Valeria Aiello; Angelodaniele Napoletano; Lorenzo Marconi; Pierluigi Viale; Marco Masina; Gaetano LA Manna Journal: In Vivo Date: 2022 Jul-Aug Impact factor: 2.406
Authors: José L Peñalvo; Els Genbrugge; Elly Mertens; Diana Sagastume; Marianne A B van der Sande; Marc-Alain Widdowson; Dominique Van Beckhoven Journal: BMJ Open Date: 2021-09-16 Impact factor: 3.006
Authors: Sandeep Singh; Annette K Offringa-Hup; Susan J J Logtenberg; Paul D Van der Linden; Wilbert M T Janssen; Hubertina Klein; Femke Waanders; Suat Simsek; Cornelis P C de Jager; Paul Smits; Machteld van der Feltz; Gerrit Jan Beumer; Christine Widrich; Martijn Nap; Sara-Joan Pinto-Sietsma Journal: Hypertension Date: 2021-06-09 Impact factor: 10.190
Authors: Francisco J de Abajo; Antonio Rodríguez-Miguel; Sara Rodríguez-Martín; Victoria Lerma; Alberto García-Lledó Journal: BMC Med Date: 2021-05-12 Impact factor: 8.775
Authors: Fabio Angeli; Paolo Verdecchia; Antonella Balestrino; Claudio Bruschi; Piero Ceriana; Luca Chiovato; Laura Adelaide Dalla Vecchia; Francesco Fanfulla; Maria Teresa La Rovere; Francesca Perego; Simonetta Scalvini; Antonio Spanevello; Egidio Traversi; Dina Visca; Michele Vitacca; Tiziana Bachetti Journal: J Cardiovasc Dev Dis Date: 2022-01-06
Authors: Jaejin An; Hui Zhou; Rong Wei; Tiffany Q Luong; Michael K Gould; Matthew T Mefford; Teresa N Harrison; Beth Creekmur; Ming-Sum Lee; John J Sim; Jeffrey W Brettler; John P Martin; Angeline L Ong-Su; Kristi Reynolds Journal: Int J Cardiol Hypertens Date: 2021-06-15