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

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.