QT prolongation in a diverse, urban population of COVID-19 patients treated with hydroxychloroquine, chloroquine, or azi
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QT prolongation in a diverse, urban population of COVID-19 patients treated with hydroxychloroquine, chloroquine, or azithromycin Brian C Hsia 1 & Nicolas Greige 2 & Jose A Quiroz 3 & Ahmed S Khokhar 3 & Johanna Daily 4,5 & Luigi Di Biase 1 & Kevin J Ferrick 1 & John D Fisher 1 & Andrew Krumerman 1 Received: 11 May 2020 / Accepted: 5 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords SARS-CoV-2 . COVID-19 . QT . Hydroxychloroquine . Chloroquine . Azithromycin
* Andrew Krumerman [email protected] Brian C Hsia [email protected]
John D Fisher [email protected] 1
Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, 111 East 210th Street, Room N2, Bronx, NY 10467, USA
2
Harold and Muriel Block Institute for Clinical and Translational Research, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
3
Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
4
Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
5
Department of Microbiology & Immunology, Albert
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