People with pre-existing diseases, especially of the heart and vessels, are particularly at risk for a severe COVID-19 outcome. The most critical pre-existing conditions include heart failure, heart attack, diabetes, and high blood pressure. Doctors all over the world observe the course of these diseases in this patient group and note any special characteristics. However, such observational studies are often too vague for treatment recommendations, and some questions are not answered at all in this way.
The studies supported by the DZHK with a total of 860,000 euros deal with telemedicine, blood pressure medication, and embolisms in COVID-19 patients. All studies are randomized, which means that patients are randomly divided into two groups, one of which receives treatment and the other standard care or a sham drug. Such studies provide the most reliable results. Clinics throughout Germany will include patients in the trials.
Identifying risk patients with the Smartwatch
A team led by Dr. Moritz Sinner of the University of Munich Hospital is focusing on the patient group of 40-60 year-olds, the largest group of COVID-19 patients in terms of numbers. Of these, up to 13 percent have one or more risk factors for a severe course. These individuals usually begin the disease in domestic quarantine, but their condition often worsens later, sometimes almost unnoticed.
Sinner and his team equip those affected with modern smartwatches that continuously measure ECG, pulse, and oxygen saturation in the blood. If the condition worsens, the patient can obtain telemedical advice via a 24-hour doctor's hotline based on the measured values, whether hospitalisation is necessary. COVID-19 patients are thus admitted to hospital in time but not endangered by unnecessary hospital stays - and the healthcare system is also relieved. (MR SPOC -Munich Remote SpO2 and Heart Rate Assessment in Covid-19 patients)
Improve chances of survival with blood thinners
Numerous observational studies and autopsies point to increased blood clots (thromboses) in patients with COVID-19, which have an unfavourable influence on the course of the disease and are probably the most frequent cardiovascular complication. Recent data evaluations, including from Mount Sinai Hospital in New York, show that patients treated with blood-thinning agents during their hospital stay had a better chance of survival.
Therefore, Prof. Ulf Landmesser from Charité - Universitätsmedizin Berlin is investigating in a Germany-wide study of CoVID-19 patients whether the blood thinner Rivaroxaban can reduce thrombotic events such as heart attacks, pulmonary embolisms or strokes and thus enable more patients to survive. The study also aims to investigate the extent to which bleeding occurs as side effects. (COVIDPREVENT: Effect of anticoagulation therapy on clinical outcomes in COVID-19)
ACE inhibitors: yes or no?
Experimental data show that the ACE2 receptor is the entry point for the SARS-Cov2 virus and is upregulated by ACE inhibitors on body cells. Patients and cardiologists alike are concerned about this. The hypothesis arose that blood pressure-lowering ACE inhibitors make it easier for the virus to spread in the body and damage essential organs. So far, there is no clinical proof of this.
In their study, Prof. Steffen Massberg and PD Konstantinos Rizas from the University Hospital Munich are investigating whether it affects the course of COVID-19 disease if ACE inhibitors are paused or replaced by antihypertensive drugs with a different mechanism of action in COVID-19 patients. The results should provide treatment safety. Until more knowledge is available, we strongly advise against discontinuing antihypertensive drugs. (ACEI-COVID-19: Stopping ACE inhibitors in COVID-19)