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Article ; Online: Nocturnal heart rate variability: A population-based screening tool?

Sappler, Nikolay / Bauer, Axel

2021 Volume 19, Issue 4, Page(s) 640–641

MeSH term(s)	Blood Pressure/physiology ; Circadian Rhythm/physiology ; Heart Rate/physiology
Language	English
Publishing date	2021-12-25
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2021.12.024
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Article ; Online: Long-term effects of discontinuing renin-angiotensin system inhibitors in COVID-19.

Theurl, Fabian / Sappler, Nikolay / Rizas, Konstantinos D / Massberg, Steffen / Bauer, Axel / Schreinlechner, Michael

Respirology (Carlton, Vic.)

2022 Volume 27, Issue 9, Page(s) 788–790

MeSH term(s)	Angiotensin Receptor Antagonists/pharmacology ; Angiotensin Receptor Antagonists/therapeutic use ; Antihypertensive Agents/pharmacology ; Antihypertensive Agents/therapeutic use ; COVID-19/drug therapy ; Humans ; Hypertension/drug therapy ; Renin-Angiotensin System ; SARS-CoV-2
Chemical Substances	Angiotensin Receptor Antagonists ; Antihypertensive Agents
Language	English
Publishing date	2022-06-07
Publishing country	Australia
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	1435849-9
ISSN	1440-1843 ; 1323-7799
ISSN (online)	1440-1843
ISSN	1323-7799
DOI	10.1111/resp.14306
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Zs.A 4957: Show issues

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Article ; Online: Smartwatch-derived heart rate variability: a head-to-head comparison with the gold standard in cardiovascular disease.

Theurl, Fabian / Schreinlechner, Michael / Sappler, Nikolay / Toifl, Michael / Dolejsi, Theresa / Hofer, Florian / Massmann, Celine / Steinbring, Christian / Komarek, Silvia / Mölgg, Kurt / Dejakum, Benjamin / Böhme, Christian / Kirchmair, Rudolf / Reinstadler, Sebastian / Bauer, Axel

European heart journal. Digital health

2023 Volume 4, Issue 3, Page(s) 155–164

Abstract: Aims: We aimed to investigate the concordance between heart rate variability (HRV) derived from the photoplethysmographic (PPG) signal of a commercially available smartwatch compared with the gold-standard high-resolution electrocardiogram (ECG)-derived ...

Abstract	Aims: We aimed to investigate the concordance between heart rate variability (HRV) derived from the photoplethysmographic (PPG) signal of a commercially available smartwatch compared with the gold-standard high-resolution electrocardiogram (ECG)-derived HRV in patients with cardiovascular disease. Methods and results: We prospectively enrolled 104 survivors of acute ST-elevation myocardial infarction, 129 patients after an ischaemic stroke, and 30 controls. All subjects underwent simultaneous recording of a smartwatch (Garmin vivoactive 4; Garmin Ltd, Olathe, KS, USA)-derived PPG signal and a high-resolution (1000 Hz) ECG for 30 min under standardized conditions. HRV measures in time and frequency domain, non-linear measures, as well as deceleration capacity (DC) were calculated according to previously published technologies from both signals. Lin's concordance correlation coefficient ( Conclusion: Smartwatch-derived HRV provides a practical alternative with excellent accuracy compared with ECG-based HRV for global markers and those characterizing lower frequency components. However, caution is warranted with HRV markers that predominantly assess short-term variability.
Language	English
Publishing date	2023-03-23
Publishing country	England
Document type	Journal Article
ISSN	2634-3916
ISSN (online)	2634-3916
DOI	10.1093/ehjdh/ztad022
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Article ; Online: Smartphone-based screening for atrial fibrillation: a pragmatic randomized clinical trial.

Rizas, Konstantinos D / Freyer, Luisa / Sappler, Nikolay / von Stülpnagel, Lukas / Spielbichler, Peter / Krasniqi, Aresa / Schreinlechner, Michael / Wenner, Felix N / Theurl, Fabian / Behroz, Amira / Eiffener, Elodie / Klemm, Mathias P / Schneidewind, Annika / Zens, Martin / Dolejsi, Theresa / Mansmann, Ulrich / Massberg, Steffen / Bauer, Axel

Nature medicine

2022 Volume 28, Issue 9, Page(s) 1823–1830

Abstract: Digital smart devices have the capability of detecting atrial fibrillation (AF), but the efficacy of this type of digital screening has not been directly compared to usual care for detection of treatment-relevant AF. In the eBRAVE-AF trial ( NCT04250220 ) ...

Abstract	Digital smart devices have the capability of detecting atrial fibrillation (AF), but the efficacy of this type of digital screening has not been directly compared to usual care for detection of treatment-relevant AF. In the eBRAVE-AF trial ( NCT04250220 ), we randomly assigned 5,551 policyholders of a German health insurance company who were free of AF at baseline (age 65 years (median; interquartile range (11) years, 31% females)) to digital screening (n = 2,860) or usual care (n = 2,691). In this siteless trial, for digital screening, participants used a certified app on their own smartphones to screen for irregularities in their pulse waves. Abnormal findings were evaluated by 14-day external electrocardiogram (ECG) loop recorders. The primary endpoint was newly diagnosed AF within 6 months treated with oral anti-coagulation by an independent physician not involved in the study. After 6 months, participants were invited to cross-over for a second study phase with reverse assignment for secondary analyses. The primary endpoint of the trial was met, as digital screening more than doubled the detection rate of treatment-relevant AF in both phases of the trial, with odds ratios of 2.12 (95% confidence interval (CI), 1.19-3.76; P = 0.010) and 2.75 (95% CI, 1.42-5.34; P = 0.003) in the first and second phases, respectively. This digital screening technology provides substantial benefits in detecting AF compared to usual care and has the potential for broad applicability due to its wide availability on ordinary smartphones. Future studies are needed to test whether digital screening for AF leads to better treatment outcomes.
MeSH term(s)	Atrial Fibrillation/diagnosis ; Atrial Fibrillation/drug therapy ; Child ; Delivery of Health Care ; Electrocardiography ; Female ; Humans ; Male ; Mass Screening ; Smartphone
Language	English
Publishing date	2022-08-28
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1220066-9
ISSN	1546-170X ; 1078-8956
ISSN (online)	1546-170X
ISSN	1078-8956
DOI	10.1038/s41591-022-01979-w
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Zs.A 4212: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Safety and efficacy of direct cardiac shockwave therapy in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (the CAST-HF trial): study protocol for a randomized controlled trial-an update.

Nägele, Felix / Pölzl, Leo / Graber, Michael / Hirsch, Jakob / Mayr, Agnes / Pamminger, Mathias / Troger, Felix / Theurl, Markus / Schreinlechner, Michael / Sappler, Nikolay / Dorfmüller, Christian / Mitrovic, Martina / Ulmer, Hanno / Grimm, Michael / Gollmann-Tepeköylü, Can / Holfeld, Johannes

Trials

2022 Volume 23, Issue 1, Page(s) 988

Abstract: Background: Coronary artery disease (CAD) remains a severe socio-economic burden in the Western world. Coronary obstruction and subsequent myocardial ischemia result in the progressive replacement of contractile myocardium with dysfunctional, fibrotic ... ...

Abstract	Background: Coronary artery disease (CAD) remains a severe socio-economic burden in the Western world. Coronary obstruction and subsequent myocardial ischemia result in the progressive replacement of contractile myocardium with dysfunctional, fibrotic scar tissue. Post-infarctional remodelling is causal for the concomitant decline of left-ventricular function and the fatal syndrome of heart failure. Available neurohumoral treatment strategies aim at the improvement of symptoms. Despite extensive research, therapeutic options for myocardial regeneration, including (stem)-cell therapy, gene therapy, cellular reprogramming or tissue engineering, remain purely experimental. Thus, there is an urgent clinical need for novel treatment options for inducing myocardial regeneration and improving left-ventricular function in ischemic cardiomyopathy. Shockwave therapy (SWT) is a well-established regenerative tool that is effective for the treatment of chronic tendonitis, long-bone non-union and wound-healing disorders. In preclinical trials, SWT regenerated ischemic myocardium via the induction of angiogenesis and the reduction of fibrotic scar tissue, resulting in improved left-ventricular function. Methods: In this prospective, randomized controlled, single-blind, monocentric study, 80 patients with reduced left-ventricular ejection fraction (LVEF≤ 40%) are subjected to coronary-artery bypass-graft surgery (CABG) surgery and randomized in a 1:1 ratio to receive additional cardiac SWT (intervention group; 40 patients) or CABG surgery with sham treatment (control group; 40 patients). This study aims to evaluate (1) the safety and (2) the efficacy of cardiac SWT as adjunctive treatment during CABG surgery for the regeneration of ischemic myocardium. The primary endpoints of the study represent (1) major cardiac events and (2) changes in left-ventricular function 12 months after treatment. Secondary endpoints include 6-min walk test distance, improvement of symptoms and assessment of quality of life. Discussion: This study aims to investigate the safety and efficacy of cardiac SWT during CABG surgery for myocardial regeneration. The induction of angiogenesis, decrease of fibrotic scar tissue formation and, thus, improvement of left-ventricular function could lead to improved quality of life and prognosis for patients with ischemic heart failure. Thus, it could become the first clinically available treatment strategy for the regeneration of ischemic myocardium alleviating the socio-economic burden of heart failure. Trial registration: ClinicalTrials.gov NCT03859466. Registered on 1 March 2019.
Language	English
Publishing date	2022-12-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-022-06931-4
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Article ; Online: Association of High-Sensitivity Cardiac Troponin T With 30-Day and 5-Year Mortality After Cardiac Surgery.

Pölzl, Leo / Engler, Clemens / Sterzinger, Philipp / Lohmann, Ronja / Nägele, Felix / Hirsch, Jakob / Graber, Michael / Eder, Jonas / Reinstadler, Sebastian / Sappler, Nikolay / Kilo, Juliane / Tancevski, Ivan / Bachmann, Sebastian / Abfalterer, Hannes / Ruttmann-Ulmer, Elfriede / Ulmer, Hanno / Griesmacher, Andrea / Heuts, Samuel / Thielmann, Matthias /

Bauer, Axel / Grimm, Michael / Bonaros, Nikolaos / Holfeld, Johannes / Gollmann-Tepeköylü, Can

Journal of the American College of Cardiology

2023 Volume 82, Issue 13, Page(s) 1301–1312

Abstract: Background: The relevance of perioperative myocardial injury (PMI) after cardiac surgery for 30-day mortality and long-term survival remains to be determined.: Objectives: This study assessed the association of PMI after cardiac surgery, reflected by ...

Abstract	Background: The relevance of perioperative myocardial injury (PMI) after cardiac surgery for 30-day mortality and long-term survival remains to be determined. Objectives: This study assessed the association of PMI after cardiac surgery, reflected by postoperative troponin release, with 30-day mortality and long-term survival after: 1) coronary artery bypass grafting (CABG); 2) isolated aortic valve replacement (AVR) surgery; and 3) all other cardiac surgeries. Methods: A consecutive cohort of 8,292 patients undergoing cardiac surgery with serial perioperative high-sensitivity cardiac troponin T (hs-cTnT) measurements was retrospectively analyzed. The relationship between postoperative hs-cTnT release and 30-day mortality or 5-year mortality was analyzed after adjustment with EuroSCORE II using a Cox proportional hazards model. hs-cTnT thresholds for 30-day and 5-year mortality were determined for isolated CABG (32.3%), AVR (14%), and other cardiac surgery (53.8%). Results: High postoperative hs-cTnT levels were associated with higher 30-day mortality but not 5-year mortality. In CABG, median peak concentration of postoperative hs-cTnT was 1,044 ng/L, in AVR it was 502 ng/L, and in other cardiac surgery it was 1,110 ng/L. hs-cTnT thresholds defining mortality-associated PMI were as follows: for CABG, 2,385 ng/L (170× the upper reference limit of normal in a seemingly healthy population [URL]); for AVR, 568 ng/L (41× URL); and for other cardiac procedures, 1,873 ng/L (134× URL). hs-cTnT levels above the cutoffs resulted in an HR for 30-day mortality for CABG of 12.56 (P < 0.001), for AVR of 4.44 (P = 0.004), and for other cardiac surgery of 3.97 (P < 0.001). Conclusions: PMI reflected by perioperative hs-cTnT release is associated with the expected 30-day mortality but not 5-year mortality. Postoperative hs-cTnT cutoffs to identify survival-relevant PMI are higher than suggested in current definitions.
MeSH term(s)	Humans ; Troponin T ; Retrospective Studies ; Cardiac Surgical Procedures ; Coronary Artery Bypass/adverse effects ; Myocardium ; Heart Injuries
Chemical Substances	Troponin T
Language	English
Publishing date	2023-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2023.07.011
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Zs.A 1846: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Rationale and design of a digital trial using smartphones to detect subclinical atrial fibrillation in a population at risk: The eHealth-based bavarian alternative detection of Atrial Fibrillation (eBRAVE-AF) trial.

Freyer, Luisa / von Stülpnagel, Lukas / Spielbichler, Peter / Sappler, Nikolay / Wenner, Felix / Schreinlechner, Michael / Krasniqi, Aresa / Behroz, Amira / Eiffener, Elodie / Zens, Martin / Dolejsi, Theresa / Massberg, Steffen / Rizas, Konstantinos D / Bauer, Axel

American heart journal

2021 Volume 241, Page(s) 26–34

Abstract: Current guidelines recommend opportunistic screening for subclinical atrial fibrillation (AF) taking advantage of e-health-based technologies. However, the efficacy of a fully scalable e-health-based strategy for AF detection in a head-to-head comparison ...

Abstract	Current guidelines recommend opportunistic screening for subclinical atrial fibrillation (AF) taking advantage of e-health-based technologies. However, the efficacy of a fully scalable e-health-based strategy for AF detection in a head-to-head comparison with routine symptom-based screening is unknown. eBRAVE-AF is an investigator-initiated, digital, prospective, randomized, siteless, open-label, cross-over study to evaluate an e-health-based strategy for detection of AF in a real-world setting. 67,488 policyholders of a large German health insurance company (Versicherungskammer Bayern, Germany) selected by age ≥ 50 years and a CHA
MeSH term(s)	Asymptomatic Diseases/epidemiology ; Atrial Fibrillation/complications ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/epidemiology ; Cross-Over Studies ; Female ; Germany/epidemiology ; Humans ; Insurance, Health/statistics & numerical data ; Male ; Middle Aged ; Mobile Applications ; Monitoring, Ambulatory/instrumentation ; Monitoring, Ambulatory/methods ; Randomized Controlled Trials as Topic/methods ; Smartphone ; Telemedicine/instrumentation ; Telemedicine/methods
Language	English
Publishing date	2021-07-09
Publishing country	United States
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2021.06.008
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Article ; Online: Periodic Repolarization Dynamics Identifies ICD Responders in Nonischemic Cardiomyopathy: A DANISH Substudy.

Circulation

2021 Volume 145, Issue 10, Page(s) 754–764

Abstract: Background: Identification of patients with nonischemic cardiomyopathy who may benefit from prophylactic implantation of a cardioverter-defibrillator. We hypothesized that periodic repolarization dynamics (PRD), a marker of repolarization instability ... ...

Abstract	Background: Identification of patients with nonischemic cardiomyopathy who may benefit from prophylactic implantation of a cardioverter-defibrillator. We hypothesized that periodic repolarization dynamics (PRD), a marker of repolarization instability associated with sympathetic activity, could be used to identify patients who will benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation. Methods: We performed a post hoc analysis of DANISH (Danish ICD Study in Patients With Dilated Cardiomyopathy), in which patients with nonischemic cardiomyopathy, left ventricular ejection fraction (LVEF) ≤35%, and elevated NT-proBNP (N-terminal probrain natriuretic peptides) were randomized to ICD implantation or control group. Patients were included in the PRD substudy if they had a 24-hour Holter monitor recording at baseline with technically acceptable ECG signals during the night hours (00:00-06:00). PRD was assessed using wavelet analysis according to previously validated methods. The primary end point was all-cause mortality. Cox regression models were adjusted for age, sex, NT-proBNP, estimated glomerular filtration rate, LVEF, atrial fibrillation, ventricular pacing, diabetes, cardiac resynchronization therapy, and mean heart rate. We proposed PRD ≥10 deg Results: A total of 748 of the 1116 patients in DANISH qualified for the PRD substudy. During a mean follow-up period of 5.1±2.0 years, 82 of 385 patients died in the ICD group and 85 of 363 patients died in the control group ( Conclusions: Increased PRD identified patients with nonischemic cardiomyopathy in whom prophylactic ICD implantation led to significant mortality reduction.
MeSH term(s)	Atrial Fibrillation ; Cardiomyopathies/diagnosis ; Cardiomyopathies/therapy ; Death, Sudden, Cardiac/prevention & control ; Defibrillators, Implantable ; Denmark/epidemiology ; Humans ; Stroke Volume ; Ventricular Function, Left
Language	English
Publishing date	2021-12-10
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.121.056464
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Article ; Online: Telemedical cardiac risk assessment by implantable cardiac monitors in patients after myocardial infarction with autonomic dysfunction (SMART-MI-DZHK9): a prospective investigator-initiated, randomised, multicentre, open-label, diagnostic trial.

Bauer, Axel / Sappler, Nikolay / von Stülpnagel, Lukas / Klemm, Mathias / Schreinlechner, Michael / Wenner, Felix / Schier, Johannes / Al Tawil, Amani / Dolejsi, Theresa / Krasniqi, Aresa / Eiffener, Elodie / Bongarth, Christa / Stühlinger, Markus / Huemer, Martin / Gori, Tommaso / Wakili, Reza / Sahin, Riza / Schwinger, Robert / Lutz, Matthias /

The Lancet. Digital health

2021 Volume 4, Issue 2, Page(s) e105–e116

Abstract: Background: Cardiac autonomic dysfunction after myocardial infarction identifies patients at high risk despite only moderately reduced left ventricular ejection fraction. We aimed to show that telemedical monitoring with implantable cardiac monitors in ... ...

Abstract	Background: Cardiac autonomic dysfunction after myocardial infarction identifies patients at high risk despite only moderately reduced left ventricular ejection fraction. We aimed to show that telemedical monitoring with implantable cardiac monitors in these patients can improve early detection of subclinical but prognostically relevant arrhythmic events. Methods: We did a prospective investigator-initiated, randomised, multicentre, open-label, diagnostic trial at 33 centres in Germany and Austria. Survivors of acute myocardial infarction with left ventricular ejection fraction of 36-50% had biosignal analysis for assessment of cardiac autonomic function. Patients with abnormal periodic repolarisation dynamics (≥5·75 deg Findings: Between May 12, 2016, and July 20, 2020, 1305 individuals were screened and 400 patients at high risk were randomly assigned (median age 64 years [IQR 57-73]); left ventricular ejection fraction 45% [40-48]) to telemedical monitoring with implantable cardiac monitors (implantable cardiac monitor group; n=201) or conventional follow-up (control group; n=199). During median follow-up of 21 months, serious arrhythmic events were detected in 60 (30%) patients of the implantable cardiac monitor group and 12 (6%) patients of the control group (hazard ratio 6·33 [IQR 3·40-11·78]; p<0·001). An improved detection rate by implantable cardiac monitors was observed for all types of serious arrhythmic events: atrial fibrillation 6 min or longer (47 [23%] patients vs 11 [6%] patients; p<0·001), atrioventricular block class IIb or higher (14 [7%] vs 0; p<0·001) and ventricular tachycardia or ventricular fibrillation (nine [4%] patients vs two [1%] patients; p=0·054). Interpretation: In patients at high risk after myocardial infarction and cardiac autonomic dysfunction but only moderately reduced left ventricular ejection fraction, telemedical monitoring with implantable cardiac monitors was highly effective in early detection of subclinical, prognostically relevant serious arrhythmic events. Funding: German Centre for Cardiovascular Research (DZHK) and Medtronic Bakken Research Center.
MeSH term(s)	Aged ; Arrhythmias, Cardiac/diagnosis ; Austria ; Female ; Germany ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic/methods ; Myocardial Infarction/complications ; Myocardial Infarction/physiopathology ; Prospective Studies ; Risk Assessment/methods ; Telemedicine/methods
Language	English
Publishing date	2021-12-03
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ISSN	2589-7500
ISSN (online)	2589-7500
DOI	10.1016/S2589-7500(21)00253-3
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Article ; Online: Discontinuation versus continuation of renin-angiotensin-system inhibitors in COVID-19 (ACEI-COVID): a prospective, parallel group, randomised, controlled, open-label trial.

Bauer, Axel / Schreinlechner, Michael / Sappler, Nikolay / Dolejsi, Theresa / Tilg, Herbert / Aulinger, Benedikt A / Weiss, Günter / Bellmann-Weiler, Rosa / Adolf, Christian / Wolf, Dominik / Pirklbauer, Markus / Graziadei, Ivo / Gänzer, Hannes / von Bary, Christian / May, Andreas E / Wöll, Ewald / von Scheidt, Wolfgang / Rassaf, Tienush / Duerschmied, Daniel /

The Lancet. Respiratory medicine

2021 Volume 9, Issue 8, Page(s) 863–872

Abstract: Background: SARS-CoV-2 entry in human cells depends on angiotensin-converting enzyme 2, which can be upregulated by inhibitors of the renin-angiotensin system (RAS). We aimed to test our hypothesis that discontinuation of chronic treatment with ACE- ... ...

Abstract	Background: SARS-CoV-2 entry in human cells depends on angiotensin-converting enzyme 2, which can be upregulated by inhibitors of the renin-angiotensin system (RAS). We aimed to test our hypothesis that discontinuation of chronic treatment with ACE-inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) mitigates the course o\f recent-onset COVID-19. Methods: ACEI-COVID was a parallel group, randomised, controlled, open-label trial done at 35 centres in Austria and Germany. Patients aged 18 years and older were enrolled if they presented with recent symptomatic SARS-CoV-2 infection and were chronically treated with ACEIs or ARBs. Patients were randomly assigned 1:1 to discontinuation or continuation of RAS inhibition for 30 days. Primary outcome was the maximum sequential organ failure assessment (SOFA) score within 30 days, where death was scored with the maximum achievable SOFA score. Secondary endpoints were area under the death-adjusted SOFA score (AUC Findings: Between April 20, 2020, and Jan 20, 2021, 204 patients (median age 75 years [IQR 66-80], 37% females) were randomly assigned to discontinue (n=104) or continue (n=100) RAS inhibition. Within 30 days, eight (8%) of 104 died in the discontinuation group and 12 (12%) of 100 patients died in the continuation group (p=0·42). There was no significant difference in the primary endpoint between the discontinuation and continuation group (median [IQR] maximum SOFA score 0·00 (0·00-2·00) vs 1·00 (0·00-3·00); p=0·12). Discontinuation was associated with a significantly lower AUC Interpretation: Discontinuation of RAS-inhibition in COVID-19 had no significant effect on the maximum severity of COVID-19 but may lead to a faster and better recovery. The decision to continue or discontinue should be made on an individual basis, considering the risk profile, the indication for RAS inhibition, and the availability of alternative therapies and outpatient monitoring options. Funding: Austrian Science Fund and German Center for Cardiovascular Research.
MeSH term(s)	Angiotensin Receptor Antagonists/administration & dosage ; Angiotensin Receptor Antagonists/adverse effects ; Angiotensin-Converting Enzyme 2/metabolism ; Angiotensin-Converting Enzyme Inhibitors/administration & dosage ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Area Under Curve ; COVID-19/epidemiology ; COVID-19/metabolism ; COVID-19/therapy ; Female ; Humans ; Hypertension/drug therapy ; Hypertension/epidemiology ; Male ; Middle Aged ; Organ Dysfunction Scores ; Outcome and Process Assessment, Health Care ; Renin-Angiotensin System/drug effects ; Renin-Angiotensin System/physiology ; Risk Adjustment/methods ; SARS-CoV-2/drug effects ; SARS-CoV-2/physiology ; Severity of Illness Index ; Withholding Treatment/statistics & numerical data
Chemical Substances	Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; ACE2 protein, human (EC 3.4.17.23) ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23)
Language	English
Publishing date	2021-06-11
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2686754-0
ISSN	2213-2619 ; 2213-2600
ISSN (online)	2213-2619
ISSN	2213-2600
DOI	10.1016/S2213-2600(21)00214-9
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In stock of ZB MED Cologne/Königswinter

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Inter-library loan at ZB MED

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In stock of ZB MED Cologne/Königswinter

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