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QT prolongation in a diverse, urban population of COVID-19 patients treated with hydroxychloroquine, chloroquine, or azithromycin.
Hsia, Brian C; Greige, Nicolas; Quiroz, Jose A; Khokhar, Ahmed S; Daily, Johanna; Di Biase, Luigi; Ferrick, Kevin J; Fisher, John D; Krumerman, Andrew.
  • Hsia BC; Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, 111 East 210th Street, Room N2, Bronx, NY, 10467, USA.
  • Greige N; Harold and Muriel Block Institute for Clinical and Translational Research, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA.
  • Quiroz JA; Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA.
  • Khokhar AS; Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA.
  • Daily J; Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA.
  • Di Biase L; Department of Microbiology & Immunology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA.
  • Ferrick KJ; Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, 111 East 210th Street, Room N2, Bronx, NY, 10467, USA.
  • Fisher JD; Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, 111 East 210th Street, Room N2, Bronx, NY, 10467, USA.
  • Krumerman A; Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, 111 East 210th Street, Room N2, Bronx, NY, 10467, USA.
J Interv Card Electrophysiol ; 59(2): 337-345, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-640049
ABSTRACT

PURPOSE:

Hydroxychloroquine, chloroquine, and azithromycin have been used for treatment of COVID-19, but may cause QT prolongation. Minority populations are disproportionately impacted by COVID-19. This study evaluates the risk of QT prolongation and subsequent outcomes after administration of these medications in largely underrepresented minority COVID-19 patients.

METHODS:

We conducted an observational study on hospitalized COVID-19 patients in the Montefiore Health System (Bronx, NY). We examined electrocardiograms (ECG) pre/post-medication initiation to evaluate QTc, HR, QRS duration, and presence of other arrhythmias.

RESULTS:

One hundred five patients (mean age 67 years; 44.8% F) were analyzed. The median time from the first dose of any treatment to post-medication ECG was 2 days (IQR 1-3). QTc in men increased from baseline (440 vs 455 ms, p < 0.001), as well as in women (438 vs 463 ms, p < 0.001). The proportion of patients with QT prolongation increased significantly (14.3% vs 34.3%, p < 0.001) even when adjusted for electrolyte abnormalities. The number of patients whose QTc > 500 ms was significantly increased after treatment (16.2% vs. 4.8%, p < 0.01). Patients with either QTc > 500 ms or an increase of 60 ms had a higher frequency of death (47.6% vs. 22.6%, p = 0.02) with an odds ratio of 3.1 (95% CI 1.1-8.7). Adjusting for race/ethnicity yielded no significant associations.

CONCLUSIONS:

Hydroxychloroquine, chloroquine, and/or azithromycin were associated with QTc prolongation but did not result in fatal arrhythmias. Our findings suggest that any harm is unlikely to outweigh potential benefits of treatment. Careful risk-benefit analyses for individual patients should guide the use of these medications. Randomized control trials are necessary to evaluate their efficacies.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Long QT Syndrome / Coronavirus Infections / Azithromycin / Electrocardiography / Antimalarials Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Vaccines Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Interv Card Electrophysiol Journal subject: Cardiology Year: 2020 Document Type: Article Affiliation country: S10840-020-00822-x

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Long QT Syndrome / Coronavirus Infections / Azithromycin / Electrocardiography / Antimalarials Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Vaccines Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Interv Card Electrophysiol Journal subject: Cardiology Year: 2020 Document Type: Article Affiliation country: S10840-020-00822-x