Beta receptor blocker therapy for the elderly in the COVID-19 era

Abstract

When the coronavirus disease 2019 (COVID-19) pandemic spread globally from the Hubei region of China in December 2019, the impact on elderly people was particularly unfavorable. The mortality associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was highest in older individuals, in whom frailty and comorbidities increased susceptibility to severe forms of COVID-19. Unfortunately, in older patients, the course of COVID-19 was often characterized by significant cardiovascular complications, such as heart failure decompensation, arrhythmias, pericarditis, and myopericarditis. Ensuring that the elderly have adequate therapeutic coverage against known cardiovascular diseases and risk factors is particularly important in the COVID-19 era. Beta blockers are widely used for the treatment and prevention of cardiovascular disease. The clinical benefits of beta blockers have been confirmed in elderly patients, and in addition to their negative chronotropic effect, sympathetic inhibition and anti-inflammatory activity are theoretically of great benefit for the treatment of COVID-19 infection. Beta blockers have not been clearly shown to prevent SARS-CoV-2 infection, but there is evidence from published studies including elderly patients that beta blockers are associated with a more favorable clinical course of COVID-19 and reduced mortality. In this minireview, we summarize the most important evidence available in the literature on the usefulness of beta blocker therapy for older patients in the context of the COVID-19 pandemic.

Insight into appropriate medication prescribing for elderly in the COVID-19 era

“…, β 2 -receptor antagonism), which worsens the respiratory condition and leads to respiratory depression. Choosing a cardio-selective beta-blocker is suggested in medical management[ 8 ] which is consistent with what has been suggested by Santillo and Migale in their review[ 2 ]. However, not all the tools propose therapeutic management.…”

“…Frailty and comorbidities increased the likelihood of a more severe clinical course. Furthermore, COVID-19 associated illness was often accompanied by cardiovascular complications, such as arrhythmia, myopericarditis, or decompensated heart failure[ 2 ].…”

“…The authors argued that although beta-blockers do not prevent infection in elderly, their use was associated with improved survival and a less severe COVID-19 clinical course. They also argued against the discontinuation of beta-blockers while having the disease[ 2 ]. However, in their review, nine of the ten studies analysed beta-blocker subgroups which represented only 20% of the enrolled patients (range 13%–41%), which is a significant limitation in making a firm conclusion.…”