TOPIC: Chest Infections
TYPE: Late Breaking
PURPOSE: Covid-19 is known to cause both lung and endovascular dysfunction. Calcium channel blockers (CCBs) have been proposed as a potential treatment for COVID-19. The use of calcium channel blockers such as amlodipine, diltiazem, and nifedipine are among first-line therapy for treating systemic and pulmonary hypertension. CCBs have also been used in high altitude pulmonary edema. The utilization of the ACE2 receptor by SARS-CoV-2 can cause diffuse pulmonary vasoconstriction. In this study, we seek to investigate whether the use of CCBs has a beneficial influence on mortality and the rate of intubation among hospitalized COVID-19 patients.
METHODS: This is a retrospective review of electronic medical records for 865 patients admitted from 3/1/2020 to 4/30/2020 who tested positive for SARS-CoV-2. Patients were divided into two groups based on whether they were prescribed CCBs or not. We examined baseline characteristics including comorbidities. The two primary outcomes measured were all-cause mortality and intubation. We used t-test for analysis of age. Pearson's chi-squared test was used for primary outcome as well as comorbidities.
RESULTS: In this study, We identified 298 patients on CCBs and 568 not on CCBs. Mean age, sex, comorbidities, and prescribed hypertension medications were compared between patients on CCBs and those not on CCBs. The data shows patients on CCBs had a mean age of 70.4 ± 13.8 compared to the non-CCB group had a mean age of 65.27 ± 18.22 (p<0.001). Male patients comprised 61% of the CCB group compared to the 56% of males in the non-CCB group (p<0.162). Patients in the CCB group were seen to have a higher incidence of underlying comorbidities compared to the non-CCB group (p<0.003). Patients in the CCB group were seen to have higher rates of being on other antihypertensive medications compared to the non-CCB group (p<0.035). Patients treated with CCBs had a higher incidence of intubation (37% vs 26%) with an odds ratio of 1.72 (CI=1.269 - 2.32, P<0.001). There was no significant difference in terms of mortality between the two groups (34% vs 39%) with an odds ratio of 0.791 (CI=0.590-1.061, p=0.118)
CONCLUSIONS: In this analysis of COVID-19 patients treated with either CCBs or non-CCBs, it was found that CCBs demonstrated a significantly elevated rate of intubation compared to the non-CCB group. We also found that the use of CCBs did not demonstrate a significant improvement to mortality, potentially due to the CCB group being older in age, having a higher number of comorbidities, and using a relatively small sample size.
CLINICAL IMPLICATIONS: CCBs should be used with caution due to its association with increased intubation. There is no demonstrated benefit of using CCBs at this time as there was no difference in mortality between patients treated with and without CCBs. Further research using clinical trials and studies with a larger group of patients is needed.
DISCLOSURES: No relevant relationships by Eleonora Akker, source=Web Response
No relevant relationships by Aaron Douen, source=Web Response
No relevant relationships by Pushpinder Kaur, source=Web Response
No relevant relationships by Ryan Panetti, source=Web Response
No relevant relationships by Shane Spiers, source=Web Response
© 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.