Pharmacotherapeutic considerations for the management of cardiovascular diseases among hospitalized COVID-19 patients

Introduction: Cardiovascular diseases (CVDs) are among the most frequently identified comorbidities in hospitalized patients with COVID-19. Patients with cardiovascular (CV) comorbidities are typically prescribed with long-term medications. We reviewed the management of co-medications prescribed for CVDs among hospitalized COVID-19 patients. Areas covered: There is no specific contraindication or caution related to COVID-19 on the use of antihypertensives unless patients develop hypotension from septic shock where all antihypertensives should be discontinued or severe hypokalemia in which continuation of RAS inhibitors is not desired. The continuation of antiplatelet and statin in case of adverse CV event should be based on risk-benefit assessment. Patients with atrial fibrillation receiving oral anticoagulants, particularly those who are critically ill, should be considered for substitution to parenteral anticoagulants. Expert opinion: An individualized approach to medication management among hospitalized patients with concurrent CVDs would seem prudent with attention paid to changes in clinical conditions and medications intended for COVID-19. The decision to change prescribed long-term medications should be entailed by close follow-up to check if a revision on the decision is needed, with resumption or a plan for resumption of any long-term medication before hospital discharge if it is discontinued during hospitalization for COVID-19, for continuity of care.