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Cardiac Complications Attributed to Hydroxychloroquine: A Systematic Review of the Literature Pre-COVID-19.
Fram, Georgi; Wang, Dee D; Malette, Kelly; Villablanca, Pedro; Kang, Guson; So, Kent; Basir, Mir B; Khan, Arfaat; McKinnon, John E; Zervos, Marcus; O'Neill, William W.
  • Fram G; Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
  • Wang DD; Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
  • Malette K; Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
  • Villablanca P; Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
  • Kang G; Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
  • So K; Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
  • Basir MB; Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
  • Khan A; Section of Cardiac Electrophysiology, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
  • McKinnon JE; Divison of Infectious Disease, Henry Ford Health System, Detroit, MMichigan, MI 48202, United States.
  • Zervos M; Divison of Infectious Disease, Henry Ford Health System, Detroit, MMichigan, MI 48202, United States.
  • O'Neill WW; Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, United States.
Curr Cardiol Rev ; 17(3): 319-327, 2021.
Article in English | MEDLINE | ID: covidwho-1435701
ABSTRACT

INTRODUCTION:

Hydroxychloroquine has been used for rheumatological diseases for many decades and is considered a safe medication. With the COVID-19 outbreak, there has been an increase in reports associating cardiotoxicity with hydroxychloroquine. It is unclear if the cardiotoxic profile of hydroxychloroquine is previously underreported in the literature or is it a manifestation of COVID-19 and therapeutic interventions. This manuscript evaluates the incidence of cardiotoxicity associated with hydroxychloroquine prior to the onset of COVID-19.

METHODS:

PubMED, EMBASE, and Cochrane databases were searched for keywords derived from MeSH terms prior to April 9, 2020. Inclusion eligibility was based on appropriate reporting of cardiac conditions and study design.

RESULTS:

A total of 69 articles were identified (58 case reports, 11 case series). The majority (84%) of patients were female, with a median age of 49.2 (range 16-92) years. 15 of 185 patients with cardiotoxic events were in the setting of acute intentional overdose. In acute overdose, the median ingestion was 17,857 ± 14,873 mg. 2 of 15 patients died after acute intoxication. In patients with long-term hydroxychloroquine use (10.5 ± 8.9 years), new onset systolic heart failure occurred in 54 of 155 patients (35%) with median cumulative ingestion of 1,493,800 ± 995,517 mg. The majority of patients improved with the withdrawal of hydroxychloroquine and standard therapy.

CONCLUSION:

Millions of hydroxychloroquine doses are prescribed annually. Prior to the COVID-19 pandemic, cardiac complications attributed to hydroxychloroquine were uncommon. Further studies are needed to understand the impact of COVID-19 on the cardiovascular system to understand the presence or absence of potential medication interactions with hydroxychloroquine in this new pathophysiological state.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cardiotoxins / Heart Diseases / Hydroxychloroquine Type of study: Experimental Studies / Observational study / Reviews / Systematic review/Meta Analysis Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: Curr Cardiol Rev Year: 2021 Document Type: Article Affiliation country: 1573403X16666201014144022

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cardiotoxins / Heart Diseases / Hydroxychloroquine Type of study: Experimental Studies / Observational study / Reviews / Systematic review/Meta Analysis Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: Curr Cardiol Rev Year: 2021 Document Type: Article Affiliation country: 1573403X16666201014144022