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. 2022 Jun 17:9:916509.
doi: 10.3389/fcvm.2022.916509. eCollection 2022.

Renin-Angiotensin-System Inhibitors Are Associated With Lower In-hospital Mortality in COVID-19 Patients Aged 80 and Older

Francesco Spannella  1   2 , Federico Giulietti  1   2 , Chiara Di Pentima  1   2 , Massimiliano Allevi  1   2 , Valentina Bordoni  1   2 , Andrea Filipponi  1   2 , Sara Falzetti  1   2 , Caterina Garbuglia  1   2 , Samuele Scorcella  1   2 , Piero Giordano  1 , Riccardo Sarzani  1   2
Affiliations

Renin-Angiotensin-System Inhibitors Are Associated With Lower In-hospital Mortality in COVID-19 Patients Aged 80 and Older

Francesco Spannella et al. Front Cardiovasc Med. .

Abstract

Background: Older adults are at higher risk of morbidity and mortality for coronavirus disease 2019 (COVID-19). Renin-angiotensin-system inhibitors (RASi) were found to have a neutral or protective effect against mortality in COVID-19 adult patients.

Aims: We investigated whether this association was confirmed also in COVID-19 older patients.

Methods: This is a prospective observational study on 337 hospitalized older adults (aged 80 years and older). We classified the study population according to usage of RASi before and during hospitalization. A propensity score analysis was also performed to confirm the findings.

Results: The mean age was 87.4 ± 6.1 years. Patients taking RASi at home were 147 (43.6%). During hospitalization, 38 patients (11.3% of the entire study population) discontinued RASi, while 57 patients (16.9% of the entire study population) started RASi. In-hospital mortality was 43.9%. Patients taking RASi during hospitalization (patients who maintained their home RASi therapy + patients who started RASi during hospitalization) had a significantly lower in-hospital mortality than untreated patients [HR 0.48 (95% CI: 0.34-0.67)], even after adjustment for required respiratory support, functional status, albumin, inflammation, and cardiac biomarkers. The analysis of the groups derived from the "propensity score matching" (58 patients in each group) confirmed these results [HR 0.46 (95% CI: 0.23-0.91)].

Discussion: Despite the high risk of death in older COVID-19 patients, RASi therapy during hospitalization was associated with a clinically relevant lower in-hospital mortality, likely due to the benefit of RAS modulation on the cardiopulmonary system during the acute phase of the disease.

Conclusion: Our findings confirm the protective role of RASi even in COVID-19 patients aged 80 years and older.

Keywords: COVID-19; mortality; older adults; propensity score matching; renin-angiotensin-system.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curves according to RASi therapy during hospitalization. (A) Overall population. (B) Propensity score matched groups.
Figure 2
Figure 2
Kaplan–Meier survival curves according to change in RASi therapy during hospitalization (A), according to ACEi or ARB therapy during hospitalization (B), and according to RASi therapy during hospitalization and admission NT-proBNP levels (C,D).
See this image and copyright information in PMC

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