Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Editorial (Evaluation Journal of Australasia, Volume 17, Issue 4)

It is with pleasure that we present the fourth and final issue of the Evaluation Journal of Australasia (EJA) for 2017. A good time to reflect on a successful year for the Australasian Evaluation Society (AES) and the EJA after an extremely well attended International Evaluation Conference in September and the growth of the EJA as it moves into 2018 under the publishership of SAGE. This move creates further benefits for the AES and its membership including: increasing visibility of the EJA to maximise readership and citations; continued access to EJA plus five other SAGE journals; 25% discount on SAGE books; and circulation to over 8,000 institutions worldwide with enhanced social media impact and outcomes, just to mention a few benefits

Editorial (Evaluation Journal of Australasia, Volume 16, Issue 4)

Welcome to the final issue of the Evaluation Journal of Australasia (EJA) for 2016. Each year the editorial team have focused on strengthening this journal through publishing on time, publishing in an ethical manner and publishing to a quality standard that contributes to the discipline of evaluation. In 2016, the editorial team wanted to foster a nurturing environment that is supportive of emerging authors and reviewers as well those who have an established publication profile

Editorial (Evaluation Journal of Australasia, Volume 17, Issue 2)

The five diverse articles chosen for this June edition of the journal highlight the increasing breadth of the field of evaluation (or perhaps of our ‘transdiscipline’, as the evaluation theorist featured in this edition’s book review might say). However, just as our methodological toolkit continues to expand and our theoretical tradition grows richer, challenges accompany this growth. The first challenge — for evaluation practitioners and theorists—is navigating this complexity. Many of you will be familiar with current evaluation themes and debates from following work in this journal and other international journals of evaluation, not to mention the always-lively annual Australasian Evaluation Society International Conference. For evaluators who contribute to the conference and this journal, a further challenge is conveying the impact of our work meaningfully across the specialisations within the field. And, of course, asking the right questions

Editorial (Evaluation Journal of Australasia, Volume 17, Issue 3)

Welcome to Issue 3, 2017 of the Evaluation Journal of Australasia (EJA) as we celebrate three years of online, on time, quarterly publication. The Editors of the EJA will once again offer a panel presentation at the Australasian Evaluation Society (AES) International Evaluation Conference in Canberra this year to explain the processes for submission, review and publication of EJA articles. Many of our authors and reviewers join us at the conference and the Editors are always excited to see newcomers to writing and reviewing who have emerged from these conference sessions. So, we would encourage you to attend our conference in the future and become part of an academic and practice based community making a significant contribution to the discipline of evaluation

Editorial (Evaluation Journal of Australasia, Volume 16, Issue 3)

My name is Sharon Clarke, my country is Wergaia on my mother's side and Gundjitimara on my father's side. In my capacity as an ordinary Board member of the Australasian Evaluation Society (AES) in 2016 I advocated for cultural safety training as a way to move forward

Editorial (Evaluation Journal of Australasia, Volume 17, Issue 1)

With 2016 done and dusted, we welcome you to 2017—the International Year of Sustainable Tourism for Development, which acknowledges the importance of international tourism, and sustainable tourism for development. The declaration by the United Nations (UN) prioritises the importance of ‘fostering better understanding among peoples everywhere, in leading to a greater awareness of the rich heritage of various civilizations and in bringing about a better appreciation of the inherent values of different cultures, thereby contributing to the strengthening of peace in the world’ (World Tourism Organization, 2015). This resolution synergises with the ‘doing’, the nuts and bolts of evaluation frameworks, and these values are evident in the papers selected for this edition. Guiding the UN’s resolution to achieve best practice is the Global Code of Ethics for Tourism (World Tourism Organization, n.d.) a comprehensive set of principles designed to guide key-players in tourism development. As we commence a fresh new year, the focus for this first editorial pivots around ethical guidelines; ethical considerations for editors, reviewers and authors; and ethics in practice today. Ethical dynamics and considerations are a recurring theme embedded within this edition. This is partially in response to excellent queries raised around publishing for evaluators at the 2016 Australasian Evaluation Society (AES) International Conference in Perth