ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Various case reports have associated transient sinus bradycardia with Remdesivir (RDV) therapy for SARS-CoV2 infection. Pallotto et al., Gubitosa et al., and Touafchia et al. all reported the association of Remdesivir with increased risk of bradycardia in small samples of patients treated with RDV for COVID-19. To our knowledge, no large studies looked at this side effect of RDV therapy. We aimed to analyze the association between sinus bradycardia and Remdesivir therapy for COVID-19. METHODS: A retrospective case-control analysis was done for 1535 patients with SARS-CoV2 infection who were admitted to four teaching hospitals in an urban area in 2020. The mean age was 66 years (SD of 16.7, range 18-99), with 774 males (50.4%). Patients were divided into cases (treated with RDV) and controls (not treated with RDV). Multivariate logistic regression methods were used to analyze the associations between independent variables and outcomes. Pulse rate variables were recorded as pulse rate at day-0, day-3, day-7, and incidence of bradycardia on three consecutive days during admission. Other variables recorded were age, gender, comorbidities, prior history of cardiac disease/arrhythmias, concomitant medications (including AV nodal blockers, dexamethasone, Albuterol, and Lasix), and ICU admission. Survival analysis was run for 7-day and 30-day mortality, as well as survival to hospital discharge. RESULTS: 1415 patients were included in the final analysis, after the exclusion of 120 patients with previous heart blocks. 600 patients (39.1%) were in the Remdesivir group, and 935 patients (60.9%) were in the control group. Between both groups, a total of 454 patients (29.6%) had transient bradycardia on three consecutive days during hospitalization. A multivariate regression analysis was done after adjusting for all confounding variables (age, gender, history of cardiac diseases, AV-nodal blocking drugs, dexamethasone, furosemide, and albuterol therapy). It was seen that there was no statistically significant association between RDV therapy and persistent transient bradycardia (transient bradycardic events on three consecutive days) (Odds Ratio 0.823, 95% confidence interval (CI) 0.594-1.134, p=0.236). There was no statistically significant association of RDV therapy with patients having any bradycardia event during hospitalization in a sub-analysis (Odds Ratio 0.888, 95% confidence interval (CI) 0.665-1.184, p=0.419). Also, RDV failed to show any statistically significant mortality benefit (OR 1.1, CI 0.75-1.62, p=0.6). CONCLUSIONS: Our findings indicate that although transient sinus bradycardia in patients with COVID-19, can be triggered by severe hypoxia, inflammatory damage to AV-nodal cells, or exaggerated response to medications, there was no statistically significant association of RDV therapy with the risk of developing bradycardia. RDV therapy should not be withheld in patients at risk of developing bradycardia. CLINICAL IMPLICATIONS: Remdesivir therapy did not increase the risk of developing bradycardia in our patient population. RDV therapy should not be withheld in patients at risk of developing bradycardia. Larger RCTs are needed to validate these findings. DISCLOSURES: No relevant relationships by Rahul Bollam, source=Web Response No relevant relationships by Bhagat Kondaveeti, source=Web Response No relevant relationships by Florencio Mamauag, source=Web Response No relevant relationships by Kainat Saleem, source=Web Response No relevant relationships by Manasi Sejpal, source=Web Response No relevant relationships by Megha Sood, source=Web Response No relevant relationships by Morgan Stalder, source=Web Response No relevant relationships by Rosalie Traficante, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response
ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Various cardiac manifestations of the COVID-19 virus have been reported since early 2020, including a range of arrhythmias, but to our knowledge, only 2 case reports exist describing new bradycardia in patients with COVID-19 infection. We aimed to analyze the association between sinus bradycardia and severity of covid-19 infection, including survival outcomes. METHODS: A retrospective analysis was done for 1535 patients with SARS-CoV2 infection who were admitted to four teaching hospitals in an urban area in 2020. The mean age was 66 years (SD of 16.7, range 18-99), with 774 males (50.4%). Multivariate logistic regression methods were used to analyze the associations between independent variables and outcomes. Pulse rate variables were recorded as pulse rate at day-0, day-3, day-7, and incidence of bradycardia on 3 consecutive days during admission. Other variables recorded were age, gender, comorbidities, prior history of cardiac disease/arrhythmias, concomitant medications (including AV nodal blockers, dexamethasone, Remdesivir, Albuterol, and Lasix), and ICU admission. The severity of COVID-19 infection was graded by the need for ICU admission vs. no ICU admission. Survival analysis was run for 7-day and 30-day mortality, as well as survival to hospital discharge. RESULTS: 1415 patients were included in the final analysis, as 120 patients with prior heart block were excluded. 508 patients (33.1%) required ICU admission due to severe hypoxia, 708 patients (46.2%) had at least one episode of significant bradycardia. Our sample population had an inpatient all-cause mortality of 18.1%. After adjusting for confounding variables, it was seen that patients with incident bradycardia on 3 consecutive days were more likely to require ICU admission than patients without these bradycardia events (Odds Ratio 1.58, p=0.001). There was no significant association of bradycardia with survival to hospital discharge (p=0.761). It was also seen in a sub-analysis that tachycardia on day-3 is statistically significantly associated with 7-day mortality, such that patients with tachycardia on day 3 had 2.9 (p<0.001) times the odds of 7-day mortality compared to those with normal heart rate. We also tested the overall significance of pulse rate at day-0, day 3, day 7, and persistent bradycardia and found that pulse at day 3 was a statistically significant predictor of 7-day mortality (p=0.001). CONCLUSIONS: Our findings suggest a possible correlation between bradycardia and the severity of COVID-19 symptoms;more severe COVID-19 cases were associated with a higher incidence of new bradycardia events. Transient sinus bradycardia can be triggered by severe hypoxia, inflammatory damage to AV-nodal cells, or exaggerated response to medications, but the exact etiology is still unknown. Bradycardia might be a warning sign of possible acute worsening of symptoms and should be monitored closely. Further studies are warranted to confirm these findings. CLINICAL IMPLICATIONS: Transient sinus bradycardia is possibly associated with a higher likelihood of ICU admission due to the severity of COVID-19 symptoms, and these patients should be monitored closely. DISCLOSURES: No relevant relationships by Firas Abdulmajeed, source=Web Response No relevant relationships by Abasin Amanzai, source=Web Response No relevant relationships by Rahul Bollam, source=Web Response No relevant relationships by Florencio Mamauag, source=Web Response No relevant relationships by Kainat Saleem, source=Web Response No relevant relationships by Morgan Stalder, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response
ABSTRACT
TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: The prevalence of cardiac arrhythmias, including atrial fibrillation (AF) in COVID-19 patients, has been evolving. Although data on the prevalence of AF is well established, its effect on mortality and survival has been inconsistent. The study aims to assess the mortality risk in Covid-19 patients who had AF during hospitalization. METHODS: A retrospective cohort study of consecutive patients admitted with a PCR confirmed COVID 19. We estimated 7-day and 30-day mortality through Kaplan-Meier survival curves and covariate-adjusted logistic regression and Cox Proportional Hazards models. We also obtained patient demographics, length of stay (LOS), Intensive Care Unit (ICU) admission, and co-morbidities, including the history of asthma, Diabetes Mellitus (DM), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), hypertension (HTN), acute kidney injury (AKI), and chronic kidney disease (CKD). RESULTS: Five hundred and fifty-four patients with COVID 19 were reviewed. A group of 82 (15%) patients were identified with AF, of which 32 (40%) patients had no prior history of AF. Compared to the non-AF group, these patients were significantly older (78 vs. 69 years old), more likely to be white (77% vs. 63%), have a longer LOS (11 vs. 7), and have an ICU admission (55% vs. 24%). They also had significantly increased 7-day (16% vs. 5%) and 30-day mortality (43% vs. 12%). Additionally, they were more likely to have a history of DM, CHF, AKI, and HTN. AF during admission was associated with an increased risk of 7-day and 30-day mortality (OR=2.28, p=0.039 and OR = 3.56, p < 0.001, respectively). This group also had a significantly lower survival probability at 7 days and 30 days (p=0.005, p < 0.0001, respectively). New-onset AF was associated with an increased risk of 30-day mortality (OR = 5.72 p < 0.001) and lower survival probability at 30 days (p=0.005) only. Cox Proportional Hazards regression analysis for AF on admission and new-onset AF were significant at 30-days (HR=1.9 [1.2-3] p=0.0037 and HR=2 [1.1-3.4] p=0.0173, respectively). CONCLUSIONS: Our study shows that COVID 19 patients with AF have significantly worse outcomes than patients without AF. In our population, since AF patients were older and had more co-comorbidities, higher LOS, and ICU admission, a cause-and-effect relationship cannot be confidently determined. However, adjusting for these co-variates still produced a statistically significant negative effect on mortality and survival. CLINICAL IMPLICATIONS: The driving force behind the high incidence of AF, whether due to systemic illness or Covid 19 infection, remains to be determined, but it should be noted that COVID 19 patients with AF, especially new-onset AF have higher mortality. DISCLOSURES: No relevant relationships by Abasin Amanzai, source=Web Response No relevant relationships by Amerpreet Brar, source=Web Response No relevant relationships by Jamil Masood, source=Web Response No relevant relationships by NIRZARI PANDYA, source=Web Response No relevant relationships by Manasi Sejpal, source=Web Response No relevant relationships by Aaron Walker, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response