Hydroxychloroquine/Azithromycin Therapy and QT Prolongation in Hospitalized Patients With COVID-19

This study aimed to characterize corrected QT (QTc) prolongation in a cohort of hospitalized patients with coronavirus disease-2019 (COVID-19) who were treated with hydroxychloroquine and azithromycin (HCQ/AZM). HCQ/AZM is being widely used to treat COVID-19 despite the known risk of QT interval pro...

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Bibliographic Details
Published in:JACC. Clinical electrophysiology 2021-01, Vol.7 (1), p.16-25
Main Authors: O’Connell, Thomas F., Bradley, Christopher J., Abbas, Amr E., Williamson, Brian D., Rusia, Akash, Tawney, Adam M., Gaines, Rick, Schott, Jason, Dmitrienko, Alex, Haines, David E.
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Anti-Bacterial Agents - adverse effects
azithromycin
Azithromycin - adverse effects
Body Mass Index
Comorbidity
COVID-19
COVID-19 - drug therapy
COVID-19 - epidemiology
Creatinine - blood
Drug Therapy, Combination
Electrocardiography
Enzyme Inhibitors - adverse effects
Female
Heart Failure - epidemiology
Hospitalization
Humans
hydroxychloroquine
Hydroxychloroquine - adverse effects
Long QT Syndrome - chemically induced
Long QT Syndrome - epidemiology
Male
Middle Aged
Mortality
New Research Paper
Proportional Hazards Models
QT prolongation
Risk Factors
SARS-CoV-2
torsades de pointes
Troponin I - blood
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Summary:This study aimed to characterize corrected QT (QTc) prolongation in a cohort of hospitalized patients with coronavirus disease-2019 (COVID-19) who were treated with hydroxychloroquine and azithromycin (HCQ/AZM). HCQ/AZM is being widely used to treat COVID-19 despite the known risk of QT interval prolongation and the unknown risk of arrhythmogenesis in this population. A retrospective cohort of COVID-19 hospitalized patients treated with HCQ/AZM was reviewed. The QTc interval was calculated before drug administration and for the first 5 days following initiation. The primary endpoint was the magnitude of QTc prolongation, and factors associated with QTc prolongation. Secondary endpoints were incidences of sustained ventricular tachycardia or ventricular fibrillation and all-cause mortality. Among 415 patients who received concomitant HCQ/AZM, the mean QTc increased from 443 ± 25 ms to a maximum of 473 ± 40 ms (87 [21%] patients had a QTc ≥500 ms). Factors associated with QTc prolongation ≥500 ms were age (p 
ISSN:2405-500X
2405-5018
DOI:10.1016/j.jacep.2020.07.016