{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:43:20Z","timestamp":1787971400784,"version":"build-2784847793"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,12,7]],"date-time":"2020-12-07T00:00:00Z","timestamp":1607299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["523\u20132014\u20102336"],"award-info":[{"award-number":["523\u20132014\u20102336"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Renin\u2013angiotensin\u2013aldosterone system inhibitors (RAASi) improve outcomes in cardiorenal disease but concerns have been raised over increased risk of incident hospitalization and death from coronavirus disease 2019 (COVID\u201019). We investigated the association between use of angiotensin\u2010converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs) or mineralocorticoid receptor antagonists (MRAs) and COVID\u201019 hospitalization\/death in a large nationwide population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients with hypertension, heart failure, diabetes, kidney disease, or ischaemic heart disease registered in the Swedish National Patient Registry until 1 February 2020 were included and followed until 31 May 2020. COVID\u201019 cases were defined based on hospitalization\/death for COVID\u201019. Multivariable logistic and Cox regressions were fitted to investigate the association between ACEi\/ARB and MRA and risk of hospitalization\/death for COVID\u201019 in the overall population, and of all\u2010cause mortality in COVID\u201019 cases. We performed consistency analysis to quantify the impact of potential unmeasured confounding. Of 1\u2009387\u2009746 patients (60% receiving ACEi\/ARB and 5.8% MRA), 7146 (0.51%) had incident hospitalization\/death from COVID\u201019. After adjustment for 45 variables, ACEi\/ARB use was associated with a reduced risk of hospitalization\/death for COVID\u201019 (odds ratio 0.86, 95% confidence interval 0.81\u20130.91) in the overall population, and with reduced mortality in COVID\u201019 cases (hazard ratio 0.89, 95% confidence interval 0.82\u20130.96). MRA use was not associated with risk of any outcome. Consistency analysis showed that unmeasured confounding would need to be large for there to be harmful signals associated with RAASi use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a 1.4 million nationwide cohort, use of RAASi was not associated with increased risk of hospitalization for or death from COVID\u201019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2060","type":"journal-article","created":{"date-parts":[[2020,11,22]],"date-time":"2020-11-22T05:03:30Z","timestamp":1606021410000},"page":"476-485","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Association between renin\u2013angiotensin\u2013aldosterone system inhibitor use and COVID\u201019 hospitalization and death: a 1.4 million patient nationwide registry analysis"],"prefix":"10.1093","volume":"23","author":[{"given":"Gianluigi","family":"Savarese","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine Karolinska Institutet  Stockholm Sweden"},{"name":"Heart and Vascular Theme Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Benson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Sundstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Clinical Epidemiology Uppsala Universitet  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars H.","family":"Lund","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Karolinska Institutet  Stockholm Sweden"},{"name":"Heart and Vascular Theme Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,12,7]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsr2005760"},{"key":"e_1_2_5_3_1","unstructured":"European Society of Cardiology. Position Statement of the ESC Council on Hypertension on ACE\u2010inhibitors and Angiotensin Receptor Blockers.https:\/\/www.escardio.org\/Councils\/Council\u2010on\u2010Hypertension\u2010(CHT)\/News\/position\u2010statement\u2010of\u2010the\u2010esc\u2010council\u2010on\u2010hypertension\u2010on\u2010ace\u2010inhibitors\u2010and\u2010ang(8 July 2020)."},{"key":"e_1_2_5_4_1","unstructured":"American College of Cardiology.HFSA\/ACC\/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID\u201019.https:\/\/www.acc.org\/latest\u2010in\u2010cardiology\/articles\/2020\/03\/17\/08\/59\/hfsa\u2010acc\u2010aha\u2010statement\u2010addresses\u2010concerns\u2010re\u2010using\u2010raas\u2010antagonists\u2010in\u2010covid\u201019(8 July 2020)."},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2002125"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2008975"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2006923"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.11301"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.120.317134"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2020-317393"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcvp\/pvaa062"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.0000187500.24964.7A"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1042\/CS20200163"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.02202-13"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-016-0117-y"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.2307\/2533848"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31030-8"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.120.317174"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.2147\/JIR.S160573"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.3.314"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.14785"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2019.08.049"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2020.04.068"},{"key":"e_1_2_5_24_1","unstructured":"European Society of Cardiology.First randomised trial backs safety of common heart drugs in COVID\u201019 patients.https:\/\/www.escardio.org\/The\u2010ESC\/Press\u2010Office\/Press\u2010releases\/LOPES(25 November 2020)."},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1614394"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejhf.2060","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ejhf.2060","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejhf.2060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T12:15:26Z","timestamp":1767701726000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ejhf.2060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,7]]},"references-count":24,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1002\/ejhf.2060"],"URL":"https:\/\/doi.org\/10.1002\/ejhf.2060","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.739090198.793584929","asserted-by":"object"}]},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,7]]},"assertion":[{"value":"2020-09-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}