Prehospital period in patients with COVID-19 and community acquired pneumonia: age characteristics, cardiovascular comorbidity and pharmacotherapy during epidemic wave (the data of hospital registry)
Authors: Lukiyanov M , Martsevich S Y , Pulin A A , Kutishenko N P , Andreenko E Y , Dindikova V A , Makoveeva A N , Okshina E Y , Dmitrieva N A , Lerman O V , Voronina V P , Zagrebelnyy A V , Klyashtorny V G , Karpov O E , Drapkina O M 
Published: October 2021

Abstract

Aim
To estimate age characteristics, proportion of concomitant cardiovascular diseases (CVD), cardiovascular pharmacotherapy during prehospital period in patients with COVID-19 and community acquired pneumonia (CAP) according the data of hospital registry.

Methods
The registry included all patients admitted to the special COVID-19 center from April 6 to June 2, 2020 with suspected or confirmed COVID-19 and CAP. This enrollment period was corresponding to the main part of the first epidemic wave of COVID-19 in megapolis (the number of new cases on April 6 and July 2, 2020 was 591 and 662, respectively, the maximal number, 6703 cases, was registered on May 7). COVID-19 was diagnosed in cases of positive polymerase chain reaction test (60.7%) or according to computed tomography data.

Results
The registry included 1.130 patients (age 57.5±12.8 years, 51.2% men). CAP was diagnosed in 94% of cases, CVD - in 52.9%. Mean age values (from the 1-st up to the 11-th weeks of enrollment period) were, respectively, week by week: 52.8; 54.3; 57.3; 59.6; 56.9; 60.0; 57.2; 62.7; 59.3; 57.4 and 62.2 years (p&lt;0.001; β-coefficient 0.78; 95% Confidential Interval, CI 0.50–1.07). The proportion of patients with CVD was for each of these weeks, respectively: 34.2%; 43.0%; 52.9%; 53.5%; 50.5%; 61.4%; 53.9%; 68.9; 63.1%; 54.8% and 66.7% (p&lt;0.001; Odds Ratio 1.04; 95% CI 1.02–1.06). So, during enrollment period the mean age of patients increased significantly (on average by 0.78 years per week) as well as the proportion of CVD cases increased from 34.2% up to 66.7% (average 51.5%). The mean duration of period from the first day of clinical symptoms until the date of hospitalization was 8.3±5.9 days (median 7; with Q1-Q3 from 5 to 10). There were no significant difference for the length of this period between groups of patients with and without CVD: 8.4±6.2 and 8.3±5.7 days (median 7; with Q1-Q3 from 5 to 10 for both groups), p=0.82; between age groups of ≥65 years and &lt;65 years: 8.8±7.2 and 8.1±5.3 days (median 7 with Q1-Q3 from 5 to 10, and 7 with Q1-Q3 from 4 to 10, respectively), p=0.07. Antihypertensive therapy during prehospital period was administered in 78.4% cases of hypertension, ACE inhibitors/sartans in patients with chronic heart failure (CHF) and history of myocardial infarction (MI) - in 64.6% and 52.3%, beta-blockers in CHF and history of MI – 54.4% and 42.2%, statins in coronary artery disease (CAD) – 28.9%, antiplatelets in CAD without atrial fibrillation (AF) – 50.4%, anticoagulants in AF – 57.5%.

Conclusions
Prehospital period in patients with COVID-19, community-acquired pneumonia enrolled into the hospital registry was characterized by rising of age and proportion of CVD cases during enrollment period. The correspondence of cardiovascular pharmacotherapy to clinical guidelines was insufficient that must be improved in clinical practice during time interval between first symptoms and hospitalization date.

Funding Acknowledgement
Type of funding sources: None.