Effect of the chronic medication use on outcome measures of hospitalized COVID-19 patients: Evidence from big data

Abstract

BackgroundConcerns about the role of chronically used medications in the clinical outcomes of the coronavirus disease 2019 (COVID-19) have remarkable potential for the breakdown of non-communicable diseases (NCDs) management by imposing ambivalence toward medication continuation. This study aimed to investigate the association of single or combinations of chronically used medications in NCDs with clinical outcomes of COVID-19.MethodsThis retrospective study was conducted on the intersection of two databases, the Iranian COVID-19 registry and Iran Health Insurance Organization. The primary outcome was death due to COVID-19 hospitalization, and secondary outcomes included length of hospital stay, Intensive Care Unit (ICU) admission, and ventilation therapy. The Anatomical Therapeutic Chemical (ATC) classification system was used for medication grouping. The frequent pattern growth algorithm was utilized to investigate the effect of medication combinations on COVID-19 outcomes.FindingsAspirin with chronic use in 10.8% of hospitalized COVID-19 patients was the most frequently used medication, followed by Atorvastatin (9.2%) and Losartan (8.0%). Adrenergics in combination with corticosteroids inhalants (ACIs) with an odds ratio (OR) of 0.79 (95% confidence interval: 0.68–0.92) were the most associated medications with less chance of ventilation therapy. Oxicams had the least OR of 0.80 (0.73–0.87) for COVID-19 death, followed by ACIs [0.85 (0.77–0.95)] and Biguanides [0.86 (0.82–0.91)].ConclusionThe chronic use of most frequently used medications for NCDs management was not associated with poor COVID-19 outcomes. Thus, when indicated, physicians need to discourage patients with NCDs from discontinuing their medications for fear of possible adverse effects on COVID-19 prognosis.

Pathological Interplay and Clinical Complications between COVID-19 and Cardiovascular Diseases: An Overview in 2023

“…Another meta-analysis in 2023 also indicated that metformin therapy of type 2 diabetes mellitus also help reduce in-hospital mortality of COVID-19 [16]. Evidence from Iranian COVID-19 registry and Iran Health Insurance Organization demonstrated the use of medications for underlying chronic diseases reduced the severity of COVID-19, including amlodipine-hydrochlorothiazide (−16% in hospital stay), losartan (−18% in ventilation therapy), diuretics (−15% in ventilation therapy), and biguanide (−13% in mortality) [17]. These data suggested that the regular drugs should not be discontinued in conjunction with the treatment of COVID-19.…”

“…Arrhythmia was first reported among ICU patients with COVID-19 in China, where more than 40% of ICU patients in this study developed arrhythmias, which affected only 7% of patients with COVID-19 not admitted to the ICU [17]. Another study in the USA reported a 9.6% rate of arrhythmias [44], in which atrial fibrillation was the most commonly reported tachyarrhythmia at 20.8%, along with paroxysmal supraventricular tachycardia at 5.7%, atrial flutter at 5.4%, and sustained atrial tachycardia at 3.5%.…”

“…Ultimately, a formal exercise program should be initiated. There has been some empirical evidence that standardized medication (including ACEI, ARBs, statins, anticoagulant, and metformin) can improve the prognosis of COVID-19 by reducing inflammation, improving the neurohumoral system, and improving ventricular remodeling [15][16][17][18]. Therefore, for PASC-CVD, we should give medical treatment according to the respective treatment guide (myocarditis, coronary vascular disease, hypertension, atrial, or ventricular arrhythmias) to improve symptoms.…”

Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data

“…While previous ecological studies used medication sales data to estimate drug prescription patterns and their adherence to clinical guidelines, using health claims data as individual-based database, could offer a deeper understanding of evidence-based treatment and its changes over time ( 11 , 12 ). In the case of COVID-19, the claims data proved effective in drawing different aspects of disease management and its impact on patient outcomes ( 13 , 14 ). Research in this field shows that the prescription of different medications could majorly affect the course of disease and outcomes like mortality in patients with COVID-19 infection ( 14 , 15 ).…”

“…In the case of COVID-19, the claims data proved effective in drawing different aspects of disease management and its impact on patient outcomes ( 13 , 14 ). Research in this field shows that the prescription of different medications could majorly affect the course of disease and outcomes like mortality in patients with COVID-19 infection ( 14 , 15 ). Previous research on this topic showed that the most used medications in hospitalized patients with suspected or confirmed COVID-19 were corticosteroids, antithrombotics, and antibiotics, each varying impact on infection course and outcomes ( 16 , 17 ).…”