ArticleEuropean journal of heart failure2021
Association between renin-angiotensin-aldosterone system inhibitor use and COVID-19 hospitalization and death: a 1.4 million patient nationwide registry analysis.
Article in European journal of heart failure, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 60 citations in OpenAlex.
- Risk phenotypes of diabetes and association with COVID-19 severity and death: an update of a living systematic review and meta-analysis.Diabetologia · 2023Pooled it
- Renin-Angiotensin Aldosterone System Inhibitors and COVID-19: A Systematic Review and Meta-Analysis Revealing Critical Bias Across a Body of Observational Research.Journal of the American Heart Association · 2022Pooled it
- Short-Term Exposure to Low and High Temperatures and Mortality Among Patients With Heart Failure in Sweden.JAMA cardiology · 2025Article
- A Transformer-Based Framework for Counterfactual Estimation of Antihypertensive Treatment Effect on COVID-19 Infection Risk - A Proof-of-Concept Study.American journal of hypertension · 2025Article
- Treat or not treat COVID-19 with combined renin-angiotensin system and neprilysin inhibition: Have we found a solution?European journal of heart failure · 2025Article
- COVID-19 in Relation to Chronic Antihistamine Prescription.Microorganisms · 2024Article
- Use of drugs for hypertension or heart failure and the risk of death in COVID-19: association with loop-diuretics.European journal of clinical pharmacology · 2024Article
- Guideline-directed medical therapy prescribing patterns and in-hospital outcomes among heart failure patients during COVID-19.American heart journal plus : cardiology research and practice · 2024Article
- Aldosterone levels do not predict 28-day mortality in patients treated for COVID-19 in the intensive care unit.Scientific reports · 2024Article
- Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study.JMIR public health and surveillance · 2023Article
- Trust in information sources as a moderator of the impact of COVID-19 anxiety and exposure to information on conspiracy thinking and misinformation beliefs: a multilevel study.BMC psychology · 2023Article
- Association between use of novel glucose-lowering drugs and COVID-19 hospitalization and death in patients with type 2 diabetes: a nationwide registry analysis.European heart journal. Cardiovascular pharmacotherapy · 2022Article
- Heart failure: an update from the last years and a look at the near future.ESC heart failure · 2022Review
- Renin-angiotensin-aldosterone system inhibitors and the COVID-19 epidemic.Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology · 2022Article
- COVID-19 and kidney disease: insights from epidemiology to inform clinical practice.Nature reviews. Nephrology · 2022Review
- Article
- Impact of more variations on in-hospital mortality among patients with confirmed COVID-19.Journal of clinical hypertension (Greenwich, Conn.) · 2022Article
- The elderly at risk: aldosterone as modulator of the immune response to SARS-CoV-2 infection.GeroScience · 2022Article
- Association between Mineralocorticoid Receptor Antagonist and Mortality in SARS-CoV-2 Patients: A Systematic Review and Meta-Analysis.Healthcare (Basel, Switzerland) · 2022Review
- Renin-angiotensin system blockers during the COVID-19 pandemic: an update for patients with hypertension and chronic kidney disease.Clinical kidney journal · 2022Review
Corrections and comments
- Commented on by
Authors and funding
4 authors at 3 institutions in 1 country.
Funding
Abstract
aimsRenin-angiotensin-aldosterone system inhibitors (RAASi) improve outcomes in cardiorenal disease but concerns have been raised over increased risk of incident hospitalization and death from coronavirus disease 2019 (COVID-19). We investigated the association between use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs) or mineralocorticoid receptor antagonists (MRAs) and COVID-19 hospitalization/death in a large nationwide population. METHODS AND
resultsPatients with hypertension, heart failure, diabetes, kidney disease, or ischaemic heart disease registered in the Swedish National Patient Registry until 1 February 2020 were included and followed until 31 May 2020. COVID-19 cases were defined based on hospitalization/death for COVID-19. Multivariable logistic and Cox regressions were fitted to investigate the association between ACEi/ARB and MRA and risk of hospitalization/death for COVID-19 in the overall population, and of all-cause mortality in COVID-19 cases. We performed consistency analysis to quantify the impact of potential unmeasured confounding. Of 1 387 746 patients (60% receiving ACEi/ARB and 5.8% MRA), 7146 (0.51%) had incident hospitalization/death from COVID-19. After adjustment for 45 variables, ACEi/ARB use was associated with a reduced risk of hospitalization/death for COVID-19 (odds ratio 0.86, 95% confidence interval 0.81-0.91) in the overall population, and with reduced mortality in COVID-19 cases (hazard ratio 0.89, 95% confidence interval 0.82-0.96). MRA use was not associated with risk of any outcome. Consistency analysis showed that unmeasured confounding would need to be large for there to be harmful signals associated with RAASi use.
conclusionsIn a 1.4 million nationwide cohort, use of RAASi was not associated with increased risk of hospitalization for or death from COVID-19.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.