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Erschienen in: Journal of Interventional Cardiac Electrophysiology 2/2020

11.07.2020 | COVID-19 Zur Zeit gratis

QT prolongation in a diverse, urban population of COVID-19 patients treated with hydroxychloroquine, chloroquine, or azithromycin

verfasst von: Brian C Hsia, Nicolas Greige, Jose A Quiroz, Ahmed S Khokhar, Johanna Daily, Luigi Di Biase, Kevin J Ferrick, John D Fisher, Andrew Krumerman

Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 2/2020

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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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Metadaten
Titel
QT prolongation in a diverse, urban population of COVID-19 patients treated with hydroxychloroquine, chloroquine, or azithromycin
verfasst von
Brian C Hsia
Nicolas Greige
Jose A Quiroz
Ahmed S Khokhar
Johanna Daily
Luigi Di Biase
Kevin J Ferrick
John D Fisher
Andrew Krumerman
Publikationsdatum
11.07.2020
Verlag
Springer US
Schlagwort
COVID-19
Erschienen in
Journal of Interventional Cardiac Electrophysiology / Ausgabe 2/2020
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-020-00822-x

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