BRACE CORONA research points to the possibility of merging and integrating medical practices for the treatment of cardiac patients infected with COVID-19
Researchers of the D’Or Institute for Research and Education (IDOR) and the Brazilian Clinical Research Institute (BCRI), supported by Duke University, have recently provided solid evidence that cardiac patients infected with COVID-19 can (and should) continue to be provided with their regular cardiac therapy during their inpatient care as such regular therapy has proven to not adversely affect or escalate their infection rate by the new coronavirus. The study entitled BRACE CORONA, one of the initiatives endeavored by IDOR’s Science Project Against COVID-19 (CIC-19), was the only Brazilian study to participate in the session called The Late-Breaking Clinical Trials of ESC Congress 2020, the major cardiology congress in the world that was held earlier this month. The full research paper is scheduled to be published by a renowned scientific journal and so to be soon available.
When it became known that the highest COVID-19 mortality rate patients were the elderly and individuals with comorbidities, our researchers immediately turned their attention to cardiac patients who fit this profile. Such zeal focused on the medication prescribed to manage cardiovascular insufficiency and blood pressure, since by the time the BRACE CORONA research started there was no knowledge whether cardiac therapy might aggravate COVID-19 or not.
In Brazil, some 40% of the population have hypertension, amongst which 80% are treated with either of these two drugs -angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme (ACE) inhibitors. ACE is one of the major enzymes to regulate the cardiovascular system and both drugs are commonly used to manage cardiovascular insufficiency and blood pressure. Insecurity about whether to continue administering the drugs stemmed from some studies suggesting that these drugs increase the availability of the angiotensin-converting enzyme 2, or ACE2 “receptor,” the protein that provides the entry point for the SARS-Cov-2 virus to hook into and infect human cells. However, findings of the BRACE CORONA study show that this protein did not yield relevant clinical outcomes.
According to the leading cardiology researcher with IDOR and professor with Duke University, Dr. Renato Lopes, the decision to undertake a randomized study, viewed as the gold standard of clinical trials, aimed to have quicker practical answers to manage the pandemic. “We were not testing a hypothesis, but aiming to establish a cause-effect relationship – should we stop drug administration or not?”. Lopes added that the study was not only randomized but also hybrid, as its randomization process was carried out with a voluminous database of records in effect at Rede D’Or São Luiz (RDSL), which made recruiting the sampling population quicker and yielded more relevant data about COVID-19 patients. “Adopting this hybrid model for the first time in Brazil was quite an innovation for a country this big, where data varies widely from one state to another. However, as RDSL has everything standardized, we were able to use this model across this huge country”.
The study divided 659 inpatients with light to moderate COVID-19, spread over almost 30 hospitals of the RDSL network, into two sampling groups. For one group, administration of ARBs and ACE for chronic conditions was maintained, while for the other group ARBs and ACE administration was suspended for one month. The primary reference of outcomes was the rate of patients that made it through and were discharged from the hospital after 30 days. The sampling population who continued receiving their drug administration showed slightly better clinical results and 95% were discharged after 30 days. Of the sampling group whose drug administration was suspended, 91.8% were discharged after the same period of time.
These results show that suspending ARBs and ACE administration does not produce significant clinical outcomes in what refers to light and moderate COVID-19 infection, but rather may favor greater survival for patients whose cardiovascular treatment was maintained. These findings allowed BRACE CORONA to supply a definite answer to the maintenance of ARBs and ACE administration for COVID-19 patients who have cardiac comorbidity, thus reassuring this population of possible positive outcomes and clarifying that these medical practices should be carried out all over the world from now on.