QT prolongation in a diverse, urban population of COVID-19 patients treated with hydroxychloroquine, chloroquine, or azithromycin
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..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:59 |
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| Enthalten in: |
Journal of interventional cardiac electrophysiology - 59(2020), 2 vom: 11. Juli, Seite 337-345 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hsia, Brian C [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
Azithromycin |
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| Anmerkungen: |
© Springer Science+Business Media, LLC, part of Springer Nature 2020 |
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| doi: |
10.1007/s10840-020-00822-x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
OLC2120559791 |
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| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
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| 245 | 1 | 0 | |a QT prolongation in a diverse, urban population of COVID-19 patients treated with hydroxychloroquine, chloroquine, or azithromycin |
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| 500 | |a © Springer Science+Business Media, LLC, part of Springer Nature 2020 | ||
| 520 | |a 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. | ||
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a QT | |
| 650 | 4 | |a Hydroxychloroquine | |
| 650 | 4 | |a Chloroquine | |
| 650 | 4 | |a Azithromycin | |
| 700 | 1 | |a Greige, Nicolas |4 aut | |
| 700 | 1 | |a Quiroz, Jose A |4 aut | |
| 700 | 1 | |a Khokhar, Ahmed S |4 aut | |
| 700 | 1 | |a Daily, Johanna |4 aut | |
| 700 | 1 | |a Di Biase, Luigi |4 aut | |
| 700 | 1 | |a Ferrick, Kevin J |4 aut | |
| 700 | 1 | |a Fisher, John D |4 aut | |
| 700 | 1 | |a Krumerman, Andrew |4 aut | |
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