TY - JOUR
T1 - Comorbidities, cardiovascular therapies, and COVID-19 mortality
T2 - A nationwide, italian observational study (ItaliCO)
AU - The ItaliCO study group
AU - Polverino, Francesca
AU - Stern, Debra A.
AU - Ruocco, Gaetano
AU - Balestro, Elisabetta
AU - Bassetti, Matteo
AU - Candelli, Marcello
AU - Cirillo, Bruno
AU - Contoli, Marco
AU - Corsico, Angelo
AU - D’Amico, Filippo
AU - D’Elia, Emilia
AU - Falco, Giuseppe
AU - Gasparini, Stefano
AU - Guerra, Stefano
AU - Harari, Sergio
AU - Kraft, Monica
AU - Mennella, Luigi
AU - Papi, Alberto
AU - Parrella, Roberto
AU - Pelosi, Paolo
AU - Poletti, Venerino
AU - Polverino, Mario
AU - Tana, Claudio
AU - Terribile, Roberta
AU - Woods, Jason C.
AU - Di Marco, Fabiano
AU - Martinez, Fernando D.
AU - Zhang, Shuyang
AU - Geelhoed, Bastiaan
AU - Sinning, Christoph
AU - Agarossi, A.
AU - Agati, S.
AU - Agosteo, E.
AU - Ando’, F.
AU - Andreoni, M.
AU - Angelillo, I. F.
AU - Arcoleo, G.
AU - Arena, C.
AU - Baiamonte, P.
AU - Ball, L.
AU - Banfi, P.
AU - Bartoletti, G.
AU - Bartolotta, R.
AU - Battaglini, D.
AU - Bellan, M.
AU - Benzoni, I.
AU - Bertolini, R.
AU - Bevilacqua, M.
AU - Bezzi, M.
AU - Bianco, A.
N1 - Publisher Copyright:
© 2020 Polverino, Stern, Ruocco, Balestro, Bassetti, Candelli, Cirillo, Contoli, Corsico, D’Amico, D’Elia, Falco, Gasparini, Guerra, Harari, Kraft, Mennella, Papi, Parrella, Pelosi, Poletti, Polverino, Tana, Terribile, Woods, Di Marco, Martinez and the ItaliCO study group.
PY - 2020
Y1 - 2020
N2 - Background: Italy has one of the world’s oldest populations, and suffered one the highest death tolls from Coronavirus disease 2019 (COVID-19) worldwide. Older people with cardiovascular diseases (CVDs), and in particular hypertension, are at higher risk of hospitalization and death for COVID-19. Whether hypertensionmedicationsmay increase the risk for death in older COVID 19 inpatients at the highest risk for the disease is currently unknown. Methods: Data from 5,625 COVID-19 inpatients were manually extracted from medical charts from 61 hospitals across Italy. From the initial 5,625 patients, 3,179 were included in the study as they were either discharged or deceased at the time of the data analysis. Primary outcome was inpatient death or recovery. Mixed effects logistic regression models were adjusted for sex, age, and number of comorbidities, with a random effect for site. Results: A large proportion of participating inpatients were ≥65 years old (58%), male (68%), non-smokers (93%) with comorbidities (66%). Each additional comorbidity increased the risk of death by 35% [adjOR = 1.35 (1.2, 1.5) p < 0.001]. Use of ACE inhibitors, ARBs, beta-blockers or Ca-antagonists was not associated with significantly increased risk of death. There was a marginal negative association between ARB use and death, and a marginal positive association between diuretic use and death. Conclusions: This Italian nationwide observational study of COVID-19 inpatients, the majority of which ≥65 years old, indicates that there is a linear direct relationship between the number of comorbidities and the risk of death. Among CVDs, hypertension and pre-existing cardiomyopathy were significantly associated with risk of death. The use of hypertension medications reported to be safe in younger cohorts, do not contribute significantly to increased COVID-19 related deaths in an older population that suffered one of the highest death tolls worldwide.
AB - Background: Italy has one of the world’s oldest populations, and suffered one the highest death tolls from Coronavirus disease 2019 (COVID-19) worldwide. Older people with cardiovascular diseases (CVDs), and in particular hypertension, are at higher risk of hospitalization and death for COVID-19. Whether hypertensionmedicationsmay increase the risk for death in older COVID 19 inpatients at the highest risk for the disease is currently unknown. Methods: Data from 5,625 COVID-19 inpatients were manually extracted from medical charts from 61 hospitals across Italy. From the initial 5,625 patients, 3,179 were included in the study as they were either discharged or deceased at the time of the data analysis. Primary outcome was inpatient death or recovery. Mixed effects logistic regression models were adjusted for sex, age, and number of comorbidities, with a random effect for site. Results: A large proportion of participating inpatients were ≥65 years old (58%), male (68%), non-smokers (93%) with comorbidities (66%). Each additional comorbidity increased the risk of death by 35% [adjOR = 1.35 (1.2, 1.5) p < 0.001]. Use of ACE inhibitors, ARBs, beta-blockers or Ca-antagonists was not associated with significantly increased risk of death. There was a marginal negative association between ARB use and death, and a marginal positive association between diuretic use and death. Conclusions: This Italian nationwide observational study of COVID-19 inpatients, the majority of which ≥65 years old, indicates that there is a linear direct relationship between the number of comorbidities and the risk of death. Among CVDs, hypertension and pre-existing cardiomyopathy were significantly associated with risk of death. The use of hypertension medications reported to be safe in younger cohorts, do not contribute significantly to increased COVID-19 related deaths in an older population that suffered one of the highest death tolls worldwide.
KW - ACE inhibitors
KW - COVID-19
KW - Cohort study
KW - Comorbidities
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=85097778275&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85097778275&partnerID=8YFLogxK
U2 - 10.3389/fcvm.2020.585866
DO - 10.3389/fcvm.2020.585866
M3 - Article
AN - SCOPUS:85097778275
SN - 2297-055X
VL - 7
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
M1 - 585866
ER -