Incidences of Adverse Effects of Vaccination against Sars-Cov-2 in Patients with Congenital Coagulopathies

Introduction: Traditionally, the administration of intramuscular vaccination has been avoided in patients with congenital coagulopathies due to its possible deleterious effects, including large hematomas, contractures or fibrosis. However, vaccination against SARS-CoV- 2 received approval from regulatory agencies only for intramuscular administration, since its efficacy by other routes has not been studied, so its administration was generalized by this route in this group of patients. The objective is to evaluate the possible adverse effects secondary to vaccination against COVID-19 in patients diagnosed with congenital coagulopathies in a single center. Method(s): Retrospective, analytical and single-center study documenting the adverse effects of vaccination against COVID-19 in a population diagnosed with congenital coagulopathies in a rural center in Spain. Clinical and epidemiological results were collected. Result(s): Twenty-six patients (61.5% male population) with a median age of 24 years (range 3-79 years) were evaluated. The most frequent congenital coagulopathies were deficiency of factor VII (34.6%), VIII (19.2%) and XI (19.2%). 11.5% received prophylaxis. 20% of the sample was infected during the first wave of the pandemic (pre-vaccination) without the need for hospital admission. The entire sample received vaccination in the complete scheme (3 doses, 57.7% were administered from the Pfizer-Bi brand, the difference from the Moderna-Rec brand) without evidence of significant hemorrhagic or thrombotic complications, presenting the entire sample of humoral immune response. No patient in the sample has required hospital admission secondary to severe COVID-19. Discussion/Conclusion: After completing the vaccination schedule against SARS-CoV-2, it can be inferred that the intramuscular administration of this vaccine does not produce significant hemorrhagic adverse events, being the route of preference at present.

Implementation of remote support services: Pre-COVID-19

In this national survey of departments of developmental disabilities services across the United States, we attempted to establish the number of the states that made remote support services available as an authorized service in some state Medicaid funded developmental disabilities waiver programs. Remote support services were defined as a service that uses technology to support an individual with developmental disabilities and is provided from a location outside of the person's home. Remote support services involve the use of technology to provide real-time assistance from a direct support professional from a remote location. We found that 18 of the 49 states (37%) that responded to our telephone survey reported offering some form of remote support services. This survey was conducted pre-COVID-19 and the implications of the availability of remote support services are discussed especially in light of COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Examining Help-Seeking Intentions Among Generation Z College Students

Generation Z has been impacted by various stressors, such as the COVID-19 pandemic, which have contributed to detrimental health outcomes, including elevated rates of suicide. The majority of current U.S. college students encompass members of Gen Z, who have reported more stress than other generations. College students among other generations have demonstrated low rates of help-seeking behaviors, though these older generations were less racially diverse. Hierarchical regression analyses were conducted to assess gender and racial differences in help-seeking intentions for personal and emotional problems and suicidal thoughts among a racially diverse sample of 160 college students. Participants with greater thwarted belongingness (a component of suicide desire) were less likely to seek help for personal or emotional problems, with no significant differences across race or gender. These findings suggest college counselors attend to increasing social connections;programming efforts specific to this generation;and ensuring knowledge of life-saving resources across social networks. [ABSTRACT FROM AUTHOR] Copyright of Journal of College Student Psychotherapy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Prevalence of Statin Use for Primary Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and 10-Year Disease Risk in the US: National Health and Nutrition Examination Surveys, 2013 to March 2020.

Importance: The burden of atherosclerotic cardiovascular disease (ASCVD) in the US is higher among Black and Hispanic vs White adults. Inclusion of race in guidance for statin indication may lead to decreased disparities in statin use. Objective: To evaluate prevalence of primary prevention statin use by race and ethnicity according to 10-year ASCVD risk. Design, Setting, and Participants: This serial, cross-sectional analysis performed in May 2022 used data from the National Health and Nutrition Examination Survey, a nationally representative sample of health status in the US, from 2013 to March 2020 (limited cycle due to the COVID-19 pandemic), to evaluate statin use for primary prevention of ASCVD and to estimate 10-year ASCVD risk. Participants aged 40 to 75 years without ASCVD, diabetes, low-density lipoprotein cholesterol levels 190 mg/dL or greater, and with data on medication use were included. Exposures: Self-identified race and ethnicity (Asian, Black, Hispanic, and White) and 10-year ASCVD risk category (5%-<7.5%, 7.5%-<20%, ≥20%). Main Outcomes and Measures: Prevalence of statin use, defined as identification of statin use on pill bottle review. Results: A total of 3417 participants representing 39.4 million US adults after applying sampling weights (mean [SD] age, 61.8 [8.0] years; 1289 women [weighted percentage, 37.8%] and 2128 men [weighted percentage, 62.2%]; 329 Asian [weighted percentage, 4.2%], 1032 Black [weighted percentage, 12.7%], 786 Hispanic [weighted percentage, 10.1%], and 1270 White [weighted percentage, 73.0%]) were included. Compared with White participants, statin use was lower in Black and Hispanic participants and comparable among Asian participants in the overall cohort (Asian, 25.5%; Black, 20.0%; Hispanic, 15.4%; White, 27.9%) and within ASCVD risk strata. Within each race and ethnicity group, a graded increase in statin use was observed across increasing ASCVD risk strata. Statin use was low in the highest risk stratum overall with significantly lower rates of use among Black (23.8%; prevalence ratio [PR], 0.90; 95% CI, 0.82-0.98 vs White) and Hispanic participants (23.9%; PR, 0.90; 95% CI, 0.81-0.99 vs White). Among other factors, routine health care access and health insurance were significantly associated with higher statin use in Black, Hispanic, and White adults. Prevalence of statin use did not meaningfully change over time by race and ethnicity or by ASCVD risk stratum. Conclusions and Relevance: In this study, statin use for primary prevention of ASCVD was low among all race and ethnicity groups regardless of ASCVD risk, with the lowest use occurring among Black and Hispanic adults. Improvements in access to care may promote equitable use of primary prevention statins in Black and Hispanic adults.

Impact of the COVID-19 pandemic on cardiology fellow echocardiography education at a large academic center.

BACKGROUND: In response to COVID-19 pandemic state restrictions, our institution deferred elective procedures from 3/15/2020 to 6/13/2020, and removed cardiology fellows from the echocardiography rotation to staff clinical services. We assessed the impact of the COVID-19 pandemic on fellow education and echocardiography volumes. METHODS: Our institutional database was used to examine volumes of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) from 7/1/2018 to 10/10/2020. Study volumes were compared in three intervals: pre-pandemic (7/1/2018- 3/14/2020), pandemic (3/15/2020-6/13/2020), and pandemic recovery (6/14/2020-10/10/2020). We examined weekly number of TTEs performed or interpreted by cardiology fellows during the study period, and compared these to the two previous academic years. RESULTS: Weekly TTE volume declined by 54% during the pandemic, and increased by 99% during pandemic recovery, (p < 0.05). SE and TEE revealed similar trends. A strong correlation between weekly TTE volume and inpatient admissions was observed during the study period (rs=0.67, p < 0.05). Weekly fellow TTE scans declined by 78% during the pandemic, with a 380% increase during pandemic recovery (p < 0.05). Weekly fellow TTE interpretations declined by 56% during the pandemic, with a 76% increase during pandemic recovery (p < 0.05). CONCLUSION: COVID restrictions between 3/15/2020- 6/14/2020 coincided with a marked decline in TTE, SE, and TEE volumes, with an increase similar to near pre-pandemic volumes during the pandemic recovery period. A similar decline with the onset of COVID restrictions, and increase to pre-restriction volumes thereafter was observed with fellow scans and interpretations, but total academic year fellow training volumes remained depressed. With the ongoing COVID-19 pandemic and rise of multiple variants, training programs may need to adjust fellows' clinical responsibilities so as to support achievement of echocardiography training certification.

Loss of response after discontinuation of eltrombopag in a patient with immune thrombocytopenia secondary to COVID-19: another finding of persistent COVID syndrome ?

Background: Immune thrombocytopenia (IT) is a complication described within COVID-19, probably secondary to the immunological storm produced during the acute infection. It usually responds to first-line treatment (corticosteroids, immunoglobulins), with the use of thrombopoietin (TPO) agonists being somewhat infrequent. Aim(s): The objective is to present these cases of eltrombopag-dependent immune thrombocytopenia secondary to severe COVID-19 infection within a probable context of persistent COVID syndrome . Method(s): Unicentric, descriptive study that describes our experience with two patients who presented severe forms of COVID-19 (need to stay in intensive care) during the first wave (March 2020) and who to date have depended on eltrombopag to maintain hematological response. Result(s): Two patients (women aged 67 and 65 years) with no relevant medical history, diagnosed in March and April 2020, respectively, with bibasal pneumonia secondary to severe COVID-19. On discharge they had severe IT associated with skin bleeding events, initially treated with oral prednisone mg/kg/day plus unspecific IVIg g/kg/day (no hematologic response in both cases) and dexamethasone 40 mg for 4 days plus unspecific IVIg g/kg/day every 15 days (3 cycles), without response. Second-line treatment was started with TPO analogues (oral eltrombopag 50 mg/day, with dose escalation to 75 mg/day), obtaining hematological response on day +7 of start and complete remission on day +21 of treatment. After 18 months of treatment at high doses, it was decided to de-escalate the dose, with loss of symptomatic hematological response, for which it was decided to return to the previous dose in both patients, with platelet count recovery 5-14 days later. Conclusion(s): The fact that IT is refractory to corticosteroids and, furthermore, dependent on high doses of eltrombopag (with no possibility of reduction) after almost two years of treatment, gives us an idea that the process of immune dysregulation secondary to COVID -19 persists in time, as well as its long-term consequences.

Automated analysis of limited echocardiograms: Feasibility and relationship to outcomes in COVID-19.

Background: As automated echocardiographic analysis is increasingly utilized, continued evaluation within hospital settings is important to further understand its potential value. The importance of cardiac involvement in patients hospitalized with COVID-19 provides an opportunity to evaluate the feasibility and clinical relevance of automated analysis applied to limited echocardiograms. Methods: In this multisite US cohort, the feasibility of automated AI analysis was evaluated on 558 limited echocardiograms in patients hospitalized with COVID-19. Reliability of automated assessment of left ventricular (LV) volumes, ejection fraction (EF), and LV longitudinal strain (LS) was assessed against clinically obtained measures and echocardiographic findings. Automated measures were evaluated against patient outcomes using ROC analysis, survival modeling, and logistic regression for the outcomes of 30-day mortality and in-hospital sequelae. Results: Feasibility of automated analysis for both LVEF and LS was 87.5% (488/558 patients). AI analysis was performed with biplane method in 300 (61.5%) and single plane apical 4- or 2-chamber analysis in 136 (27.9%) and 52 (10.7%) studies, respectively. Clinical LVEF was assessed using visual estimation in 192 (39.3%), biplane in 163 (33.4%), and single plane or linear methods in 104 (21.2%) of the 488 studies; 29 (5.9%) studies did not have clinically reported LVEF. LV LS was clinically reported in 80 (16.4%). Consistency between automated and clinical values demonstrated Pearson's R, root mean square error (RMSE) and intraclass correlation coefficient (ICC) of 0.61, 11.3% and 0.72, respectively, for LVEF; 0.73, 3.9% and 0.74, respectively for LS; 0.76, 24.4ml and 0.87, respectively, for end-diastolic volume; and 0.82, 12.8 ml, and 0.91, respectively, for end-systolic volume. Abnormal automated measures of LVEF and LS were associated with LV wall motion abnormalities, left atrial enlargement, and right ventricular dysfunction. Automated analysis was associated with outcomes, including survival. Conclusion: Automated analysis was highly feasible on limited echocardiograms using abbreviated protocols, consistent with equivalent clinically obtained metrics, and associated with echocardiographic abnormalities and patient outcomes.

Planning and Reporting Effective Web-Based RAND/UCLA Appropriateness Method Panels: Literature Review and Preliminary Recommendations.

BACKGROUND: The RAND/UCLA Appropriateness Method (RAM), a variant of the Delphi Method, was developed to synthesize existing evidence and elicit the clinical judgement of medical experts on the appropriate treatment of specific clinical presentations. Technological advances now allow researchers to conduct expert panels on the internet, offering a cost-effective and convenient alternative to the traditional RAM. For example, the Department of Veterans Affairs recently used a web-based RAM to validate clinical recommendations for de-intensifying routine primary care services. A substantial literature describes and tests various aspects of the traditional RAM in health research; yet we know comparatively less about how researchers implement web-based expert panels. OBJECTIVE: The objectives of this study are twofold: (1) to understand how the web-based RAM process is currently used and reported in health research and (2) to provide preliminary reporting guidance for researchers to improve the transparency and reproducibility of reporting practices. METHODS: The PubMed database was searched to identify studies published between 2009 and 2019 that used a web-based RAM to measure the appropriateness of medical care. Methodological data from each article were abstracted. The following categories were assessed: composition and characteristics of the web-based expert panels, characteristics of panel procedures, results, and panel satisfaction and engagement. RESULTS: Of the 12 studies meeting the eligibility criteria and reviewed, only 42% (5/12) implemented the full RAM process with the remaining studies opting for a partial approach. Among those studies reporting, the median number of participants at first rating was 42. While 92% (11/12) of studies involved clinicians, 50% (6/12) involved multiple stakeholder types. Our review revealed that the studies failed to report on critical aspects of the RAM process. For example, no studies reported response rates with the denominator of previous rounds, 42% (5/12) did not provide panelists with feedback between rating periods, 50% (6/12) either did not have or did not report on the panel discussion period, and 25% (3/12) did not report on quality measures to assess aspects of the panel process (eg, satisfaction with the process). CONCLUSIONS: Conducting web-based RAM panels will continue to be an appealing option for researchers seeking a safe, efficient, and democratic process of expert agreement. Our literature review uncovered inconsistent reporting frameworks and insufficient detail to evaluate study outcomes. We provide preliminary recommendations for reporting that are both timely and important for producing replicable, high-quality findings. The need for reporting standards is especially critical given that more people may prefer to participate in web-based rather than in-person panels due to the ongoing COVID-19 pandemic.

Examination of Cutaneous Changes Among Patients Following SARS-CoV-2 Infection.

Individuals infected with SARS-CoV-2 have been found to develop a variety of cutaneous symptoms. This study sought to describe varying cutaneous manifestations of COVID-19 in individuals presenting to an inpatient healthcare facility. We screened individuals who presented with COVID-19 for skin changes throughout the illness and administered a survey regarding demographics, medical history, and their cutaneous findings. Three individuals reported varying skin findings including wheals, petechiae, ecchymosis, and papules. One individual reported a worsening skin condition, psoriasis, as well as a new skin condition, seborrheic dermatitis. In conclusion, cutaneous manifestations of patients suffering from COVID-19 are wide-ranging and worsening skin conditions amongst these patients should be further investigated.

Publication timeline of chest imaging reporting in children with coronavirus disease 2019 (COVID-19): a systematic review spanning 2020.

Amid the coronavirus disease 2019 (COVID-19) pandemic, numerous publications of imaging findings in children have surfaced in a very short time. Publications discuss populations of overlapping age groups and describe different imaging patterns. We aim to present an overview of the quantity and type of literature available regarding COVID-19 chest imaging findings in children according to a 2020 publication timeline. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We searched terminology related to COVID-19, chest, children and imaging modalities in PubMed and Embase. The included papers were published online in 2020 and described imaging findings specific to children and reported five or more cases. Two researchers reviewed each abstract to determine inclusion or exclusion, and a radiologist reconciled any disagreements. Then we reviewed full articles for the main analysis. Eligible study designs included original articles, case series (≥5 cases), systematic reviews and meta-analyses. We excluded non-English manuscripts, retracted articles, and those without available full text. The remaining articles were distributed to four pediatric radiologists (on the Society for Pediatric Radiology Thoracic Committee), who summarized chest imaging findings. Eighty-two articles were included in the final analysis - 28% in radiology journals and 71% in non-radiology journals; 71% contained original data and 29% were review-style papers. There was a disproportionate contribution of review-style papers in April (55%), considering the paucity of preceding publications with original data in March (5 papers). June had the highest number of publications (n=14), followed by April (n=11) and July (n=11). Most (52%) original papers were from China and most individual pediatric imaging descriptions were from China (57%), while the majority of review papers (83%) were international. Imaging descriptions were available for 2,199 children (1,678 CT descriptions and 780 chest radiography descriptions). Findings included a 25% normal CT scan reports vs. 40% normal chest radiography reports. Ground-glass opacification was the most common CT finding (33%) and was reported in only a minority of chest radiographs (9%). A significant amount of information on pediatric COVID-19 chest imaging has become rapidly available over a short period. Most publications in 2020 were original articles, but they were published more often in non-radiology journals. A disproportionate number of review articles were published early on and were based on little original pediatric imaging data. CT scan reports, which represent the standard, outnumbered radiographic reports and indicated that ground-glass opacification is the main imaging finding and that only a quarter of scans are normal in children with COVID-19.

Clinical endpoints to inform vaccine policy: A systematic review of outcome measures from pediatric influenza vaccine efficacy trials.

INTRODUCTION: We conducted a systematic review of pediatric influenza vaccine efficacy trials to assess clinical outcome measures and whether the trials defined important public health endpoints. MATERIAL AND METHODS: We systematically identified phase 3 or 4 influenza vaccine randomized controlled trials among children ≤18 years of age with laboratory-confirmed influenza outcomes since 1980. We recorded countries, age groups, vaccine formulations, specimen collection criteria, laboratory diagnostics, primary and secondary outcome measures, and funders, and we determined income category for study countries. We used descriptive statistics to summarize study characteristics. We analyzed the studies overall and a subset of studies conducted in at least one low- and middle-income country (LMIC). RESULTS: From 6455 potentially relevant articles, we identified 41 eligible studies. Twenty-one studies (51%) were conducted in at least one LMIC, while the remaining studies (49%) were conducted in high-income countries only. Thirty-one studies (76%) included children younger than six years. We found 40 different primary outcome measures among the 41 eligible studies. Thirty-three studies (80%) reported standardized symptoms or findings which defined a primary outcome or triggered specimen collection. One study defined a primary outcome which captured more severe illness; however, cases were mostly due to high body temperature without other severity criteria. Of the 21 studies from at least one LMIC, 15 (71%) were published since 2010 and 17 (81%) enrolled children younger than six years. Eighteen (86%) studies from at least one LMIC reported standardized symptoms or findings which defined a primary outcome or triggered specimen collection. CONCLUSIONS: Among pediatric influenza vaccine efficacy trials, primary outcome measures and clinical specimen collection criteria were highly variable and, with one exception, focused on capturing any influenza illness. As most LMICs do not have influenza vaccination programs, our study highlights a potential data limitation affecting policy and implementation decisions in these settings.

Implementation of remote support services: Pre-COVID-19

In this national survey of departments of developmental disabilities services across the United States, we attempted to establish the number of the states that made remote support services available as an authorized service in some state Medicaid funded developmental disabilities waiver programs. Remote support services were defined as a service that uses technology to support an individual with developmental disabilities and is provided from a location outside of the person's home. Remote support services involve the use of technology to provide real-time assistance from a direct support professional from a remote location. We found that 18 of the 49 states (37%) that responded to our telephone survey reported offering some form of remote support services. This survey was conducted pre-COVID-19 and the implications of the availability of remote support services are discussed especially in light of COVID-19.

Immune thrombocytopenia refractory to corticoid therapy secondary to COVID-19. A single-centre experience

Background : Although immune thrombocytopenia (IT) is uncommon, it has been described as one of the complications secondary to infection by SARS-CoV-2, probably secondary, amongst other factors, to the underlying immune dysregulation. The very few cases reported in the literature show excellent responses to corticoid therapy. Aims : The objective of this study is to show our experience with 2 patients who had severe symptomatic corticoid-refractory IT as a complication of COVID-19. Methods : A descriptive, single-centre study that shows our experience with 2 patients diagnosed with severe COVID-19 and a long-term stay at the Intensive Care Unit (ICU), who had severe symptomatic corticoid-refractory IT, an uncommon manifestation according to the very few series reported to date. Results : Two patients (women aged 65-67 years) with no relevant medical history, diagnosed in 03-2020 and 04-2020, respectively, with bibasal pneumonia secondary to severe COVID-19, needing stay at the ICU and assisted ventilation and long-term stay. On discharge they had severe IT associated with skin bleeding events, initially treated with oral prednisone mg/kg/day plus unspecific IVIg g/kg/day, initially obtaining a good response, but followed by early loss of response in both cases. It was decided to switch protocol to IV dexamethasone 40 mg for 4 days plus unspecific IVIg g/kg/day every 15 days, of which they received 3 cycles, without response and with increased skin stigmata of bleeding. Second-line treatment was started with TPO analogues (oral eltrombopag 50 mg/day, with dose escalation to 75 mg/day), obtaining haematological response on day +7 of start and complete remission on day +21 of treatment. Currently complete response persists, with no documented adverse events. Conclusions : Although uncommon, corticoid-refractory IT is a documented bleeding diathesis in severe COVID-19. Our experience shows that the early start of TPO analogues (in the absence of response to corticoid therapy) is an effective, well-tolerated option in patients with this complication.

Real-world experience of rIX-FP prophylaxis at dosing intervals of up to 14 days in a pediatric patient with hemophilia B during the COVID-19 pandemic

Background : rIX-FP, a recombinant factor IX (rFIX) linked with recombinant human albumin, has demonstrated efficacy in prophylactic regimens up to every 21 days in patients with hemophilia B. Aims : To describe real world experience for a rural pediatric patient during the COVID-19 pandemic. Methods : Demographic, clinical (HEAD-US and Hemophilia Joint Health Score) and pharmacokinetic (PK) data were collected for up to one year following a switch from rFIX to rIX-FP. Results : In May 2018, a 3-year-old patient (moderate hemophilia B, FIX: 2.7 IU/dL) experienced hemarthrosis in the left knee and initiated prophylaxis with rFIX (40 IU/kg 2×/week). In March 2020, the patient switched to weekly rIX-FP prophylaxis (40 IU/kg), due to difficulties with venous access and accessing the clinic during the pandemic. Trough levels of 7.7% two weeks post-infusion and 5.1% 20 days post-infusion were maintained. Functional and joint assessment on day 90 of rIX-FP treatment showed no change, and no FIX inhibitors developed. On day 95 of treatment, a post-traumatic otorrhagia subsided after a single 40 IU/kg dose of rIX-FP. On day 120, the treatment interval was extended to 10 days without complications. After 160 days, the patient was diagnosed with an asymptomatic SARS-CoV-2 infection and self-isolated at home for 14 days with no changes to prophylactic treatment. On day 200, after a new PK study (trough levels of 6.9% at 14 days post-infusion), the prophylaxis interval was prolonged to 70 IU/kg every 14 days without incident. With 14-day dose intervals, monthly consumption reduced by 56.2% and the number of infusions by 75% compared with the initial rFIX treatment, without affecting efficacy or adherence. Conclusions : Switching to rIX-FP in this pediatric patient reduced the number of administrations and clinic visits without affecting efficacy or adherence, a fact that is relevant in the current context of the pandemic.

Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor use and COVID-19-related outcomes among US Veterans.

BACKGROUND: Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) may positively or negatively impact outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the association of ARB or ACEI use with coronavirus disease 2019 (COVID-19)-related outcomes in US Veterans with treated hypertension using an active comparator design, appropriate covariate adjustment, and negative control analyses. METHODS AND FINDINGS: In this retrospective cohort study of Veterans with treated hypertension in the Veterans Health Administration (01/19/2020-08/28/2020), we compared users of (A) ARB/ACEI vs. non-ARB/ACEI (excluding Veterans with compelling indications to reduce confounding by indication) and (B) ARB vs. ACEI among (1) SARS-CoV-2+ outpatients and (2) COVID-19 hospitalized inpatients. The primary outcome was all-cause hospitalization or mortality (outpatients) and all-cause mortality (inpatients). We estimated hazard ratios (HR) using propensity score-weighted Cox regression. Baseline characteristics were well-balanced between exposure groups after weighting. Among outpatients, there were 5.0 and 6.0 primary outcomes per 100 person-months for ARB/ACEI (n = 2,482) vs. non-ARB/ACEI (n = 2,487) users (HR 0.85, 95% confidence interval [CI] 0.73-0.99, median follow-up 87 days). Among outpatients who were ARB (n = 4,877) vs. ACEI (n = 8,704) users, there were 13.2 and 14.8 primary outcomes per 100 person-months (HR 0.91, 95%CI 0.86-0.97, median follow-up 85 days). Among inpatients who were ARB/ACEI (n = 210) vs. non-ARB/ACEI (n = 275) users, there were 3.4 and 2.0 all-cause deaths per 100 person months (HR 1.25, 95%CI 0.30-5.13, median follow-up 30 days). Among inpatients, ARB (n = 1,164) and ACEI (n = 2,014) users had 21.0 vs. 17.7 all-cause deaths, per 100 person-months (HR 1.13, 95%CI 0.93-1.38, median follow-up 30 days). CONCLUSIONS: This observational analysis supports continued ARB or ACEI use for patients already using these medications before SARS-CoV-2 infection. The novel beneficial association observed among outpatients between users of ARBs vs. ACEIs on hospitalization or mortality should be confirmed with randomized trials.