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Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (4): 611-614     DOI: 10.31083/j.rcm.2020.04.260
Original Research Previous articles | Next articles
Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection
Brian C. Procter1, Casey Ross1, Vanessa Pickard1, Erica Smith1, Cortney Hanson1, Peter A. McCullough2, 3, 4, *()
1McKinney Family Medicine, McKinney, 75070, TX, USA
2Baylor University Medical Center, Dallas, 75226, TX, USA
3Baylor Heart and Vascular Institute, Dallas, 75226, TX, USA
4Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, 75226, TX, USA
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Abstract:
There is an emergency need for early ambulatory treatment of Coronavirus Disease 2019 (COVID-19) in acutely ill patients in an attempt to reduce disease progression and the risks of hospitalization and death. Such management should be applied in high-risk patients age > 50 years or with one or more medical problems including cardiovascular disease. We evaluated a total of 922 outpatients from March to September 2020. All patients underwent contemporary real-time polymerase chain reaction (PCR) assay tests from anterior nasal swab samples. Patients age 50.5 ± 13.7 years (range 12 to 89), 61.6% women, at moderate or high risk for COVID-19 received empiric management via telemedicine. At least two agents with antiviral activity against SARS-CoV-2 (zinc, hydroxychloroquine, ivermectin) and one antibiotic (azithromycin, doxycycline, ceftriaxone) were used along with inhaled budesonide and/or intramuscular dexamethasone consistent with the emergent science on early COVID-19 treatment. For patients with high severity of symptoms, urgent in-clinic administration of albuterol nebulizer, inhaled budesonide, and intravenous volume expansion with supplemental parenteral thiamine 500 mg, magnesium sulfate 4 grams, folic acid 1 gram, vitamin B12 1 mg. A total of 320/922 (34.7%) were treated resulting in 6/320 (1.9%) and 1/320 (0.3%) patients that were hospitalized and died, respectively. We conclude that early ambulatory (not hospitalized, treated at home), multidrug therapy is safe, feasible, and associated with low rates of hospitalization and death. Early treatment should be considered for high-risk patients as an emergency measure while we await randomized trials and guidelines for ambulatory management.
Key words:  SARS-CoV-2      COVID-19      multidrug      hospitalization      mortality      ambulatory      antiviral      zinc      hydroxychloroquine      ivermectin      doxycycline      azithromycin      vitamin      corticosteroid     
Submitted:  26 November 2020      Revised:  09 December 2020      Accepted:  14 December 2020      Published:  30 December 2020     
*Corresponding Author(s):  Peter A. McCullough     E-mail:  peteramccullough@gmail.com

Cite this article: 

Brian C. Procter, Casey Ross, Vanessa Pickard, Erica Smith, Cortney Hanson, Peter A. McCullough. Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection. Reviews in Cardiovascular Medicine, 2020, 21(4): 611-614.

URL: 

https://rcm.imrpress.com/EN/10.31083/j.rcm.2020.04.260     OR     https://rcm.imrpress.com/EN/Y2020/V21/I4/611

[1] Ritu Thamman, Rajesh Janardhanan. Cardiac rehabilitation using telemedicine: the need for tele cardiac rehabilitation[J]. Reviews in Cardiovascular Medicine, 2020, 21(4): 497-500.
[2] Alexandru Burlacu, Radu Crisan-Dabija, Adrian Covic, Catalin Raiu, Ionut Mavrichi, Iolanda Valentina Popa, Manuel Lillo-Crespo. Pandemic lockdown, healthcare policies and human rights: integrating opposed views on COVID-19 public health mitigation measures[J]. Reviews in Cardiovascular Medicine, 2020, 21(4): 509-516.
[3] Peter A. McCullough, Paul E. Alexander, Robin Armstrong, Cristian Arvinte, Alan F. Bain, Richard P. Bartlett, Robert L. Berkowitz, Andrew C. Berry, Thomas J. Borody, Joseph H. Brewer, Adam M. Brufsky, Teryn Clarke, Roland Derwand, Alieta Eck, John Eck, Richard A. Eisner, George C. Fareed, Angelina Farella, Silvia N. S. Fonseca, Charles E. Geyer Jr., Russell S. Gonnering, Karladine E. Graves, Kenneth B. V. Gross, Sabine Hazan, Kristin S. Held, H. Thomas Hight, Stella Immanuel, Michael M. Jacobs, Joseph A. Ladapo, Lionel H. Lee, John Littell, Ivette Lozano, Harpal S. Mangat, Ben Marble, John E. McKinnon, Lee D. Merritt, Jane M. Orient, Ramin Oskoui, Donald C. Pompan, Brian C. Procter, Chad Prodromos, Juliana Cepelowicz Rajter, Jean-Jacques Rajter, C. Venkata S. Ram, Salete S. Rios , Harvey A. Risch, Michael J. A. Robb, Molly Rutherford, Martin Scholz, Marilyn M. Singleton, James A. Tumlin, Brian M. Tyson, Richard G. Urso, Kelly Victory, Elizabeth Lee Vliet, Craig M. Wax, Alexandre G. Wolkoff, Vicki Wooll, Vladimir Zelenko. Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19)[J]. Reviews in Cardiovascular Medicine, 2020, 21(4): 517-530.
[4] Jasjit S. Suri, Anudeep Puvvula, Misha Majhail, Mainak Biswas, Ankush D. Jamthikar, Luca Saba, Gavino Faa, Inder M. Singh, Ronald Oberleitner, Monika Turk, Saurabh Srivastava, Paramjit S. Chadha, Harman S. Suri, Amer M. Johri, Vijay Nambi, J Miguel Sanches , Narendra N. Khanna, Klaudija Viskovic, Sophie Mavrogeni, John R. Laird, Arindam Bit, Gyan Pareek, Martin Miner, Antonella Balestrieri, Petros P. Sfikakis, George Tsoulfas, Athanasios Protogerou, Durga Prasanna Misra, Vikas Agarwal, George D. Kitas, Raghu Kolluri, Jagjit Teji, Michele Porcu, Mustafa Al-Maini, Ann Agbakoba, Meyypan Sockalingam, Ajit Sexena, Andrew Nicolaides, Aditya Sharma, Vijay Rathore, Vijay Viswanathan, Subbaram Naidu, Deepak L. Bhatt. Integration of cardiovascular risk assessment with COVID-19 using artificial intelligence[J]. Reviews in Cardiovascular Medicine, 2020, 21(4): 541-560.
[5] A. Verner Venegas-Vera, Gates B Colbert, Edgar V. Lerma. Positive and negative impact of social media in the COVID-19 era[J]. Reviews in Cardiovascular Medicine, 2020, 21(4): 561-564.
[6] Chia-Te Liao, Wei-Ting Chang, Wen-Liang Yu, Han Siong Toh. Management of acute cardiovascular events in patients with COVID-19[J]. Reviews in Cardiovascular Medicine, 2020, 21(4): 577-581.
[7] Gates B. Colbert, A. Verner Venegas-Vera, Edgar V. Lerma. Utility of telemedicine in the COVID-19 era[J]. Reviews in Cardiovascular Medicine, 2020, 21(4): 583-587.
[8] Qi Yao, Jian Ni , Tong-Tong Hu, Zhu-Lan Cai, Jin-Hua Zhao, Qing-Wen Xie, Chen Liu,Qing-Qing Wu. Clinical characteristics and outcomes in coronavirus disease 2019 (COVID-19) patients with and without hypertension: a retrospective study[J]. Reviews in Cardiovascular Medicine, 2020, 21(4): 615-625.
[9] Yin-jun Mao, Hang Wang, Jian-xing Chen, Pin-fang Huang. Meta-analysis of medical management versus catheter ablation for atrial fibrillation[J]. Reviews in Cardiovascular Medicine, 2020, 21(3): 419-432.
[10] Niloofar Deravi, Mobina Fathi, Kimia Vakili, Shirin Yaghoobpoor, Marzieh Pirzadeh, Melika Mokhtari, Tara Fazel, Elahe Ahsan, Samad Ghaffari. SARS-CoV-2 infection in patients with diabetes mellitus and hypertension: a systematic review[J]. Reviews in Cardiovascular Medicine, 2020, 21(3): 385-397.
[11] Ramesh K. Goyal, Jaseela Majeed, Rajiv Tonk, Mahaveer Dhobi, Bhoomika Patel, Kalicharan Sharma, Subbu Apparsundaram. Current targets and drug candidates for prevention and treatment of SARS-CoV-2 (COVID-19) infection[J]. Reviews in Cardiovascular Medicine, 2020, 21(3): 365-384.
[12] Jun Zhang, Kristen M. Tecson, Peter A. McCullough. Endothelial dysfunction contributes to COVID-19-associated vascular inflammation and coagulopathy[J]. Reviews in Cardiovascular Medicine, 2020, 21(3): 315-319.
[13] Jun Zhang, Peter A. McCullough, Kristen M. Tecson. Vitamin D deficiency in association with endothelial dysfunction: Implications for patients with COVID-19[J]. Reviews in Cardiovascular Medicine, 2020, 21(3): 339-344.
[14] Allison Zimmerman, Dinesh Kalra. Usefulness of machine learning in COVID-19 for the detection and prognosis of cardiovascular complications[J]. Reviews in Cardiovascular Medicine, 2020, 21(3): 345-352.
[15] Ajay K. Mahenthiran, Ashorne K. Mahenthiran, Jo Mahenthiran. Cardiovascular system and COVID-19: manifestations and therapeutics[J]. Reviews in Cardiovascular Medicine, 2020, 21(3): 399-409.
[1] Eli M. Roth, Michael H. Davidson. PCSK9 Inhibitors: Mechanism of Action, Efficacy, and Safety[J]. Reviews in Cardiovascular Medicine, 2018, 19(S1): 31 -46 .
[2] Sandeep K. Krishnan, Norman E. Lepor. Acute and Chronic Cardiovascular Effects of Hyperkalemia: New Insights Into Prevention and Clinical Management[J]. Reviews in Cardiovascular Medicine, 2016, 17(S1): 9 -21 .
[3] Ibrahim Sidiqi, Patrick Alexander. Current Advances in Endovascular Therapy for Infrapopliteal Artery Disease[J]. Reviews in Cardiovascular Medicine, 2015, 16(1): 36 -50 .
[4] Prakash C. Deedwania. Management of Patients With Stable Angina and Type 2 Diabetes[J]. Reviews in Cardiovascular Medicine, 2015, 16(2): 105 -113 .
[5] Peter Shalit. Management of Dyslipidemia in Patients With Human Immunodeficiency Virus[J]. Reviews in Cardiovascular Medicine, 2014, 15(S1): 38 -46 .
[6] Sophie Mavrogeni, Fabrizio Cantini, Gerald M. Pohost. Systemic Vasculitis: An Underestimated Cause of Heart Failure—Assessment by Cardiovascular Magnetic Resonance[J]. Reviews in Cardiovascular Medicine, 2013, 14(1): 49 -55 .
[7] George L. Smith. Appropriate Use Criteria: The Gold Standard, or a Mechanism for the Derogation of Clinical Judgment?[J]. Reviews in Cardiovascular Medicine, 2011, 12(2): 105 .
[8] Prabhjot Singh Nijjar, Anoop Parameswaran, Aman M. Amanullah. Evaluation of Anomalous Aortic Origins of the Coronaries by 64-Slice Cardiac Computed Tomography[J]. Reviews in Cardiovascular Medicine, 2007, 8(3): 175 -181 .
[9] . SELF-ASSESSMENT POST-TEST[J]. Reviews in Cardiovascular Medicine, 2006, 7(S2): 51 -52 .
[10] Norman E. Lepor. Vascular Disease and Erectile Dysfunction[J]. Reviews in Cardiovascular Medicine, 2005, 6(2): 127 -128 .