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Abstract
Introduction: The Coronavirus disease 2019 (COVID-19) outbreak is a whole Earth health emergency related to a highly pathogenic human coronavirus responsible for severe acute respiratory syndrome (SARS-CoV-2). Despite the fact that the majority of infected patients were managed in outpatient settings, little is known about the clinical characteristics of COVID-19 patients not requiring hospitalization. The aim of our study was to describe the clinical comorbidity and the pharmacological therapies of COVID-19 patients managed in outpatient settings. Materials and Methods: We performed an observational, retrospective analysis of laboratory-confirmed COVID-19 patients managed in outpatient settings in Naples, Italy between 9 March and 1 May 2020. Data were sourced from the prospectively maintained Health Search (HS)/Thales database, shared by 128 primary care physicians (PCPs) in Naples, Italy. The clinical features and pharmacological therapies of COVID-19 patients not requiring hospitalization and managed in outpatient settings have been described. Results: A total of 351 laboratory-confirmed COVID-19 patients (mean age 54 ± 17 years; 193 males) with outpatient management were evaluated. Hypertension was the most prevalent comorbidity (35%). The distribution of cardiovascular comorbidities showed no gender-related differences. A total of 201 patients (57.3%) were treated with at least one experimental drug for COVID-19. Azithromycin, alone (42.78%) or in combination (27.44%), was the most widely used experimental anti-COVID drug in outpatient settings. Low Molecular Weight Heparin and Cortisone were prescribed in 24.87% and 19.4% of the study population, respectively. At multivariate regression model, diabetes (risk ratio (RR): 3.74; 95% CI 1.05 to 13.34; p = 0.04) and hypertension (RR: 1.69; 95% CI 1.05 to 2.7; p = 0.03) were significantly associated with the experimental anti-COVID drug administration. Moreover, only diabetes (RR: 2.43; 95% CI 1.01 to 5.8; p = 0.03) was significantly associated with heparin administration. Conclusions: Our data show a high prevalence of hypertension, more likely treated with renin–angiotensin–aldosterone system (RASS) inhibitors, among COVID-19 patients not requiring hospitalization. Experimental COVID-19 therapies have been prescribed to COVID-19 patients considered at risk for increased venous thromboembolism based on concomitant comorbidities, in particular diabetes and hypertension.
Highlights
Human coronaviruses (HCoVs) are enveloped nonsegmented positive-strand RNA viruses, with rapid evolution owing to their high genomic nucleotide substitution rates and recombination
Our results suggest the hypothesis that the high prevalence of both hypertension and renin–angiotensin aldosterone system (RAAS) inhibitors use among COVID-19 patients was related to patients’ age and not to the severity of the disease; according to the Italian
Our data show a high prevalence of hypertension, more likely treated with RAAS
Summary
Human coronaviruses (HCoVs) are enveloped nonsegmented positive-strand RNA viruses, with rapid evolution owing to their high genomic nucleotide substitution rates and recombination. The Coronavirus disease 2019 (COVID-19) outbreak is a whole Earth health emergency related to a highly pathogenic human coronavirus responsible for severe acute respiratory syndrome (SARSCoV-2) [1]. In about 15% of COVID-19 patients, the clinical course of the disease may be complicated by the onset of severe interstitial pneumonia, respiratory distress syndrome (ARDS) and/or multi organ failure (MOF) that may require hospitalization; many infected patients remain asymptomatic or paucisymptomatic and are managed in outpatient settings. Previous observational studies from different countries described the baseline clinical characteristics of COVID-19 patients. It emerged that SARS-CoV-2 was more likely to affect older men with cardiovascular comorbidities, such as hypertension, diabetes and coronary artery disease [2]; they included only hospitalized subjects admitted or not to an intensive care unit (ICU). Is one of the hardest-hit countries by COVID-19, with more than 236,000 laboratory-confirmed cases by 14 June 2020 [3]
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