Comorbidities, cardiovascular therapies, and COVID-19 mortality: A nationwide, italian observational study (ItaliCO)

Francesca Polverino; Debra A. Stern; The ItaliCO study group; Gaetano Ruocco; Elisabetta Balestro; Matteo Bassetti; Marcello Candelli; Bruno Cirillo; Marco Contoli; Angelo Corsico; Filippo D’Amico; Emilia D’Elia; Giuseppe Falco; Stefano Gasparini; Stefano Guerra; Sergio Harari; Monica Kraft; Luigi Mennella; Alberto Papi; Roberto Parrella; Paolo Pelosi; Venerino Poletti; Mario Polverino; Claudio Tana; Roberta Terribile; Jason C. Woods; Fabiano Di Marco; Fernando D. Martinez; Shuyang Zhang; Bastiaan Geelhoed; Christoph Sinning; A. Agarossi; S. Agati; E. Agosteo; F. Ando’; M. Andreoni; I. F. Angelillo; G. Arcoleo; C. Arena; P. Baiamonte; L. Ball; P. Banfi; G. Bartoletti; R. Bartolotta; D. Battaglini; M. Bellan; I. Benzoni; F. Catalano; A. Grosso; F. Porru; F. Pugliese

doi:10.3389/fcvm.2020.585866

Comorbidities, cardiovascular therapies, and COVID-19 mortality: A nationwide, italian observational study (ItaliCO)

Francesca Polverino^*
, Debra A. Stern
, The ItaliCO study group
, Gaetano Ruocco
, Elisabetta Balestro
, Matteo Bassetti
, Marcello Candelli
, Bruno Cirillo
, Marco Contoli
, Angelo Corsico
, Filippo D’Amico
, Emilia D’Elia
, Giuseppe Falco
, Stefano Gasparini
, Stefano Guerra
, Sergio Harari
, Monica Kraft
, Luigi Mennella
, Alberto Papi
, Roberto Parrella

Paolo Pelosi, Venerino Poletti, Mario Polverino, Claudio Tana, Roberta Terribile, Jason C. Woods, Fabiano Di Marco, Fernando D. Martinez, Shuyang Zhang, Bastiaan Geelhoed, Christoph Sinning, A. Agarossi, S. Agati, E. Agosteo, F. Ando’, M. Andreoni, I. F. Angelillo, G. Arcoleo, C. Arena, P. Baiamonte, L. Ball, P. Banfi, G. Bartoletti, R. Bartolotta, D. Battaglini, M. Bellan, I. Benzoni, F. Catalano, A. Grosso, F. Porru, F. Pugliese

^*Corresponding author for this work

Public Health

University of Arizona
Lovelace Respiratroy Research Institute
Ospedale Scarlato
Regina Montis Regalis Hospital
Azienda Ospedale - Università Padova
San Martino Hospital Genoa
Agostino Gemelli University Hospital Foundation IRCCS
University of Rome La Sapienza
University of Ferrara
University of Pavia
IRCCS Fondazione Policlinico San Matteo - Pavia
Azienda Socio Sanitaria Territoriale Bergamo EST
Papa Giovanni XXIII Hospital
University of Modena and Reggio Emilia
Marche Polytechnic University
IRCCS Multimedica - Milano
University of Milan
San Luca Hospital
Ospedale di Trieste
Colli Hospital
Ospedale Cardarelli
L. Pierantoni GB Morganis Hospital
Mauro Scarlato Hospital
ASL Lanciano Vasto Chieti
Gruppo San Donato
University Hospital Major of Charity of Novara
Policlinico GB Rossi
University of Cincinnati
Chinese Academy of Medical Sciences
University Medical Centre Groningen
University of Hamburg
Ospedale Luigi Sacco
Ospedale Sant’Anna di Como
Clinica San Carlo (Milan)
Policlinico di Messina
University of Rome Tor Vergata
Università degli Studi della Campania Luigi Vanvitelli
Ospedali Riuniti Villa Sofia-Cervello
University of Verona
IRCCS Fondazione Don Carlo Gnocchi - Milano
Ospedale di Lucca
zienda Ospedaliera di Cosenza
Ospedale Maggiore
Azienda Ospedaliera di Cremona

Research output: Contribution to journal › Article › Academic › peer-review

65 Citations (Scopus)

26 Downloads (Pure)

Abstract

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.

Original language	English
Article number	585866
Journal	Frontiers in Cardiovascular Medicine
Volume	7
DOIs	https://doi.org/10.3389/fcvm.2020.585866
Publication status	Published - 9 Oct 2020

Bibliographical note

Funding Information:
This work was funded by the FAMRI and the Asthma and Airway Disease Research Center, University of Arizona research funds.

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.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.3389/fcvm.2020.585866Licence: CC BY

Comorbidities, Cardiovascular Therapies, and COVID-19 MortalityFinal published version, 1.91 MBLicence: CC BY

Cite this

Polverino, F., Stern, D. A., The ItaliCO study group, Ruocco, G., Balestro, E., Bassetti, M., Candelli, M., Cirillo, B., Contoli, M., Corsico, A., D’Amico, F., D’Elia, E., Falco, G., Gasparini, S., Guerra, S., Harari, S., Kraft, M., Mennella, L., Papi, A., ... Pugliese, F. (2020). Comorbidities, cardiovascular therapies, and COVID-19 mortality: A nationwide, italian observational study (ItaliCO). Frontiers in Cardiovascular Medicine, 7, Article 585866. https://doi.org/10.3389/fcvm.2020.585866

@article{af0c951d33644b46b3a72d8b766b4363,

title = "Comorbidities, cardiovascular therapies, and COVID-19 mortality: A nationwide, italian observational study (ItaliCO)",

abstract = "Background: Italy has one of the world{\textquoteright}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.",

author = "Francesca Polverino and Stern, \{Debra A.\} and \{The ItaliCO study group\} and Gaetano Ruocco and Elisabetta Balestro and Matteo Bassetti and Marcello Candelli and Bruno Cirillo and Marco Contoli and Angelo Corsico and Filippo D{\textquoteright}Amico and Emilia D{\textquoteright}Elia and Giuseppe Falco and Stefano Gasparini and Stefano Guerra and Sergio Harari and Monica Kraft and Luigi Mennella and Alberto Papi and Roberto Parrella and Paolo Pelosi and Venerino Poletti and Mario Polverino and Claudio Tana and Roberta Terribile and Woods, \{Jason C.\} and \{Di Marco\}, Fabiano and Martinez, \{Fernando D.\} and Shuyang Zhang and Bastiaan Geelhoed and Christoph Sinning and A. Agarossi and S. Agati and E. Agosteo and F. Ando{\textquoteright} and M. Andreoni and Angelillo, \{I. F.\} and G. Arcoleo and C. Arena and P. Baiamonte and L. Ball and P. Banfi and G. Bartoletti and R. Bartolotta and D. Battaglini and M. Bellan and I. Benzoni and F. Catalano and A. Grosso and F. Porru and F. Pugliese",

note = "Funding Information: This work was funded by the FAMRI and the Asthma and Airway Disease Research Center, University of Arizona research funds. Publisher Copyright: {\textcopyright} 2020 Polverino, Stern, Ruocco, Balestro, Bassetti, Candelli, Cirillo, Contoli, Corsico, D{\textquoteright}Amico, D{\textquoteright}Elia, Falco, Gasparini, Guerra, Harari, Kraft, Mennella, Papi, Parrella, Pelosi, Poletti, Polverino, Tana, Terribile, Woods, Di Marco, Martinez and the ItaliCO study group.",

year = "2020",

month = oct,

day = "9",

doi = "10.3389/fcvm.2020.585866",

language = "English",

volume = "7",

journal = "Frontiers in Cardiovascular Medicine",

issn = "2297-055X",

publisher = "Frontiers Media SA",

}

Polverino, F, Stern, DA, The ItaliCO study group, Ruocco, G, Balestro, E, Bassetti, M, Candelli, M, Cirillo, B, Contoli, M, Corsico, A, D’Amico, F, D’Elia, E, Falco, G, Gasparini, S, Guerra, S, Harari, S, Kraft, M, Mennella, L, Papi, A, Parrella, R, Pelosi, P, Poletti, V, Polverino, M, Tana, C, Terribile, R, Woods, JC, Di Marco, F, Martinez, FD, Zhang, S, Geelhoed, B, Sinning, C, Agarossi, A, Agati, S, Agosteo, E, Ando’, F, Andreoni, M, Angelillo, IF, Arcoleo, G, Arena, C, Baiamonte, P, Ball, L, Banfi, P, Bartoletti, G, Bartolotta, R, Battaglini, D, Bellan, M, Benzoni, I, Catalano, F, Grosso, A, Porru, F & Pugliese, F 2020, 'Comorbidities, cardiovascular therapies, and COVID-19 mortality: A nationwide, italian observational study (ItaliCO)', Frontiers in Cardiovascular Medicine, vol. 7, 585866. https://doi.org/10.3389/fcvm.2020.585866

TY - JOUR

T1 - Comorbidities, cardiovascular therapies, and COVID-19 mortality

T2 - A nationwide, italian observational study (ItaliCO)

AU - Polverino, Francesca

AU - Stern, Debra A.

AU - The ItaliCO study group

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 - Catalano, F.

AU - Grosso, A.

AU - Porru, F.

AU - Pugliese, F.

N1 - Funding Information: This work was funded by the FAMRI and the Asthma and Airway Disease Research Center, University of Arizona research funds. 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 - 2020/10/9

Y1 - 2020/10/9

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.

UR - https://www.scopus.com/pages/publications/85097778275

U2 - 10.3389/fcvm.2020.585866

DO - 10.3389/fcvm.2020.585866

M3 - Article

C2 - 33195473

AN - SCOPUS:85097778275

SN - 2297-055X

VL - 7

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

M1 - 585866

ER -

Comorbidities, cardiovascular therapies, and COVID-19 mortality: A nationwide, italian observational study (ItaliCO)

Abstract

Bibliographical note

UN SDGs

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