Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19
Authors: Amit N Patel
Sapan S Desai
Timothy D Henry
SreyRam Kuy
Mandeep R Mehra
Journal: New England Journal of Medicine (2020)
Discipline: CLINICAL MEDICINE
Keywords: Covid-19; cardiovascular disease; ACE inhibitors; ARBs; in-hospital death
Affiliations: From Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (M.R.M.); Surgisphere, Chicago (S.S.D.); Baylor College of Medicine and Department of Veterans Affairs, Houston (S.K.); Christ Hospital, Cincinnati (T.D.H.); the Department of Biomedical Engineering, University of Utah, Salt Lake City (A.N.P.); and HCA Research Institute, Nashville (A.N.P.).

Abstract:  Background: Coronavirus disease 2019 (Covid-19) may disproportionately affect people with cardiovascular disease. Concern has been aroused regarding a potential harmful effect of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in this clinical context. Methods: Using an observational database from 169 hospitals in Asia, Europe, and North America, we evaluated the relationship of cardiovascular disease and drug therapy with in-hospital death among hospitalized patients with Covid-19 who were admitted between December 20, 2019, and March 15, 2020, and were recorded in the Surgical Outcomes Collaborative registry as having either died in the hospital or survived to discharge as of March 28, 2020. Results: Of the 8910 patients with Covid-19 for whom discharge status was available at the time of the analysis, a total of 515 died in the hospital (5.8%) and 8395 survived to discharge. The factors we found to be independently associated with an increased risk of in-hospital death were an age greater than 65 years (mortality of 10.0%, vs. 4.9% among those ≤65 years of age; odds ratio, 1.93; 95% confidence interval [CI], 1.60 to 2.41), coronary artery disease (10.2%, vs. 5.2% among those without disease; odds ratio, 2.70; 95% CI, 2.08 to 3.51), heart failure (15.3%, vs. 5.6% among those without heart failure; odds ratio, 2.48; 95% CI, 1.62 to 3.79), cardiac arrhythmia (11.5%, vs. 5.6% among those without arrhythmia; odds ratio, 1.95; 95% CI, 1.33 to 2.86), chronic obstructive pulmonary disease (14.2%, vs. 5.6% among those without disease; odds ratio, 2.96; 95% CI, 2.00 to 4.40), and current smoking (9.4%, vs. 5.6% among former smokers or nonsmokers; odds ratio, 1.79; 95% CI, 1.29 to 2.47). No increased risk of in-hospital death was found to be associated with the use of ACE inhibitors (2.1% vs. 6.1%; odds ratio, 0.33; 95% CI, 0.20 to 0.54) or the use of ARBs (6.8% vs. 5.7%; odds ratio, 1.23; 95% CI, 0.87 to 1.74). Conclusions: Our study confirmed previous observations suggesting that underlying cardiovascular disease is associated with an increased risk of in-hospital death among patients hospitalized with Covid-19. Our results did not confirm previous concerns regarding a potential harmful association of ACE inhibitors or ARBs with in-hospital death in this clinical context. (Funded by the William Harvey Distinguished Chair in Advanced Cardiovascular Medicine at Brigham and Women's Hospital.). 

Retracted: No

PubPeer comments:
 https: twitter.com mikejohansenmd status 1267132835871305731 https: twitter.com mikejohansenmd status 1267673812402868224 https: twitter.com ADAlthousePhD status 1267796373023281154 , 
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 https: twitter.com sTeamTraen status 1267920447791824903 https: retractionwatch.com 2020 06 02 nejm-places-expression-of-concern-on-controversial-study-of-drugs-for-covid-19 , 
 Retraction on June 4, 2020 at https: www.nejm.org doi full 10.1056 NEJMc2021225  *Because all the authors were not granted access to the raw data and the raw data could not be made available to a third-party auditor, we are unable to validate the primary data sources underlying our article, u201cCardiovascular Disease, Drug Therapy, and Mortality in Covid-19.u201d1 We therefore request that the article be retracted. We apologize to the editors and to readers of the Journal for the difficulties that this has caused.* Mandeep R. Mehra, M.D. Brigham and Womenu2019s Hospital Heart and Vascular Center, Boston, MA mmehra@bwh.harvard.edu Sapan S. Desai, M.D., Ph.D. Surgisphere, Chicago, IL SreyRam Kuy, M.D., M.H.S. Baylor College of Medicine, Houston, TX Timothy D. Henry, M.D. Christ Hospital, Cincinnati, OH Amit N. Patel, M.D. University of Utah, Salt Lake City, UT *This letter was published on June 4, 2020, at NEJM.org.* ,