#VisualAbstract: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19

1. Underlying cardiovascular disease was shown to be associated with increased risk of in-hospital death among coronavirus disease 2019 (Covid-19) hospitalized patients.

2. Angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) were not shown to be associated with in-hospital mortality among COVID-19 hospitalized patients.

Evidence Rating Level: 2 (Good)

Study Rundown: Recently, there is a growing recognition of patients with underlying cardiovascular risk may be disproportionately affected by COVID-19. Previous case series studies note cardiac arrhythmias, cardiomyopathy, and cardiac arrest as the terminal events in patients with COVID-19. Furthermore, concerns are mounting of cardiovascular disease medical therapies contributing to the severity of illness in the patient population. As such, this study investigated the relationship between underlying cardiovascular disease and COVID-19 outcomes along with evaluating the association between cardiovascular therapeutics and illness mortality. The study collected patient data from the Surgical Outcomes Collaborative (Surgisphere) capturing COVID-19 infection status, underlying cardiovascular disease, and current cardiovascular medications. The study found underlying cardiovascular disease was independently associated with an increased risk of in-hospital death. The results did not show an increased risk of in-hospital mortality with ACE inhibitor or ARB use. This retrospective study was limited by the geographic patient selection for the study. Majority of the patients for the study came from Europe; however, in the timeframe used for the study, Asia was equally negatively affected by COVID-19 as seen in China and South Korea. Therefore, a better distribution of the geographic location during patient selection would have provided stronger study conclusions. Nonetheless, this study was strengthened by providing statistically analyzed data to confirm previous observations between underlying cardiovascular disease and in-hospital deaths. For physicians, these findings highlight the additional care COVID-19 patients with underlying cardiovascular conditions require to overcome the illness.

Click to read the study in NEJM