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ATHARI FADHILA NAMANDA PUTRI

NIM 2050302302

PROGRAM STUDI DOKTER SPESIALIS I ILMU PENYAKIT DALAM

RSUP DR. M. DJAMIL / FAKULTAS KEDOKTERAN UNIVERSITAS ANDALAS
PADANG
2020
Abstract

01 Backgound 02 Methods
A potential harmful 1. Observational database
effect of ACE 2. Between Desember
inhibitors and ARB 20,2021 and March 15,
on patient with 2021
cardiovascular 3. 169 hospital in Asia,
disease who are Europe, and North
suffering from Covid America
19
 Abstract
03 Results
- 8910 patients with Covid 19,
515 died in hospital and 8395
patients survived
- The are some factors
associated with an increased
risk of in-hospital death
04 Conclusions
1. Underlying cardiovascular
disease is associated with an
increased risk of in-hospital
death among patients
hospitalized with Covid-19
2. No potential harmful effect of
ACE inhibitors and ARB on
patient with cardiovascular
disease who are suffering from
Covid 19
 Covid 19 pandemic has spread around, several studies have
noted cardiac arrythmia, cardiomyopathy, and cardiac
arrest as terminal event in patient with Covid 19.

01 SARS-CoV-2 establish itself in the host through the use of

Introduction ACE2. ACE-I and ARB may increase the expression of ACE2
and thereby may confer a predisposition to more severe
infection during covid 19.

This research undertook a study to investigate the

relationship between underlying cardiovascular disease and
covid 19 outcomes and to evaluate the association between
cardiovascular drug therapy and mortality in this illness
02 Methods
Observational database
from 169 hospital in 11
Data can be analyzed after
countries in Asia, Europa,
patient’s hospitalization is
and North America, from
complete
December 20, 2019 and
March 15, 2020
Data sources
and statistical
Analysis
Multivariable logistic-
regression analysis was
performed to ascertain the
effect og age, coexisting
condition, hospital
location, medication
03. Results

The distribution of demographic

characteristic and coexisting condition
among survivors and nonsurvivors.

Nonsurvivor : older (>65

yo),white, DM, hyperlipidemia,
ACS, heart failure, cardiac
arrhytmias, COPD and current
smoking
 Among medication

1. ACE –I and statin

were more
commonly used by
survivor
2. No association
between survival
and the use of ARB
Independent Predictors of In-Hospital Death from Multivariable Logistic-Regression Analysis.

Mehra MR et al. N Engl J Med 2020;382:e102

Higher risk of in-hospital death : The use of ACE-I and statin were associated
Age >65 yo, ACS, CHF, Cardiac with better chance of survival to hospital
arrhytmia, COPD, Current smoking discharge.
No association for the use of ARB
 Infection with SARS-Cov-2 is mild to severe respiratory
illness characterized by a hyperinflammatory syndrome,

04 multiorgans dysfunction, and death.

Discussion

Use of either ACE-I or statins was associated with better

survival, but considered with extreme caution. because
this study cannot exclude the possibility of confounding
3. same antibiotics at the same dose (5-d vs 7-d gemifloxacin & 5-d vs 10-d
ceftriaxone), same antibiotics at different doses (levofloxacin (750 mg)(5-d) vs (500
mg)(7-14 d), or various length of comparator course (7 or 10d) yielded similar
findings

4. Microbiological response to 5-day antibiotic treatment was similar to that to a

longer course (S. pneumoniae, H. influenzae, M. pneumoniae, and C. pneumoniae)

5. all-cause mortality after the 5- day and longer courses did not differ

In summary, 5-day antibiotic treatment can be as effective as

a longer course for adults with CABP
05. Conclusions

Underlying cardiovascular disease is associated

with an increased risk of in-hospital death
among patients hospitalized with Covid-19.

This results did not confirm previous concerns

regarding a potential harmful association of ACE
inhibitors or ARBs with in-hospital death in this
clinical context.
 THE QUESTION (PICO) OF THE STUDY

Population/ 8910 patients with Covid-19 who admitted

problem between December 20, 2019 and March 15,
2020, evaluated the relationship of
cardiovascular disease and drug therapy with
in-hospital death among patient with Covid-19
Intervention Cardiovascular drug therapy recorded at the
time of hospital admission
Comparison Comparison between survivors and
nonsurvivors who have underlying
cardiovascular disease with Covid 19
Outcomes No increased risk of in-hospital death was found
to be associated with the use of ACE-I or ARB
 CRITICAL APPRAISAL : STUDY VALIDITY
  Yes  Can’t tell No
1. Research Question  
 Is the research question well-defined that can be answered using V
this study design?

2. Randomization      
 Were the patients randomized to the intervention and control V
groups by a well-defined method of randomization?  
 Was the randomization list concealed from patients, clinicians and  
researchers? V
 Do the patients in each group have similar characteristics at the  
beginning of the study?   V

3. Blinding      
 Were the patients and clinicians kept blinded (masked) to which V   
treatment was being given?    
 Were they kept blinded until the end of the study? V   
   Yes  Can’t tell   No

4. Follow Up V
 Were all patients counted at the end of the
study?
 If not, how many patients were lost to follow up
and for what reason? 
   Yes Can’t tell   No
5. Intervention and co-intervention
 Were the performed interventions described in sufficient detail to be V
followed by others?
 
 Other than intervention, were the two groups cared for in similar way of
treatment?   V
 
6. Selection of Outcomes  
 Does the article report all relevant outcomes including side effect? V
       
7. Effect Size  
 Was there a difference between the outcomes of the treatments? V
8. Using Result in Your own Setting      
 Are your patient so different from those studied that the results may not    V
apply to them?
V
 Is your environment so different from the one in the study that the  
methods could not be use there?  
 
THANK YOU