COVID-19 is thought to disproportionately affect people with cardiovascular disease. Concerns have been raised around whether angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) may be harmful in this context. The authors used an observational database from 169 hospitals in Asia, Europe and North America to evaluate the relationship between cardiovascular disease and drug therapy with in-hospital death among hospitalised COVID-19 patients. Of 8910 patients with COVID-19 and an available discharge status, 5.8% died in hospital and 8395 survived to discharge. Factors that were found to be independently associated with an increased risk of in-hospital death were: age >65 years (10.0% vs. 4.9%, odds ratio [OR] 1.93, 95%CI 1.60–2.41), coronary artery disease (10.2% vs. 5.2%, OR 2.70, 95%CI 2.08–3.51), heart failure (15.3% vs. 5.6%, OR 2.48, 95%CI 1.62–3.79), cardiac arrhythmia (11.5% vs. 5.6%, OR 1.95, 95%CI 1.33–2.86), chronic obstructive pulmonary disease (14.2% vs. 5.6%, OR 2.96, 95%CI 2.00–4.40) and being a current smoker (9.4% vs. 5.6%, OR 1.79, 95%CI 1.29–2.47). No increased risk of in-hospital death was found to be associated with the use of ACE inhibitors (2.1% vs. 6.1%, OR 0.33, 95%CI 0.20–0.54) or ARBs (6.8% vs. 5.7%). Therefore those patients with underlying cardiovascular disease do have an increased risk of in-hospital death but there does not appear to be a harmful association with ACE inhibitors or ARBs.
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