Inpatient Use of Ambulatory Telemetry Monitors for COVID-19 Patients Treated With Hydroxychloroquine and/or Azithromycin

Chang, David Z.; Saleh, Moussa; Gabriels, James; Ismail, Haisam; Goldner, Bruce; Willner, Jonathan; Beldner, Stuart; Mitra, Raman; John, Roy; Epstein, Laurence M.

doi:10.1016/j.jacc.2020.04.032

Cited by 62 publications

(67 citation statements)

References 4 publications

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“…Other studies have suggested that mobile cardiac outpatient telemetry may be used for QT and arrhythmia monitoring during the COVID pandemic. 12,13 However, these studies did not compare data to the standard 12-lead ECG, and our findings are consistent with a prior study comparing QTc measurements using single lead portable ECG devices and 12-lead ECG. 14 A multi-lead tracing may allow for increased diagnostic accuracy.…”

Section: Discussionsupporting

confidence: 88%

Derived telemetry-based electrocardiograms in the intensive care unit: insights from a COVID-19 epicenter

Coromilas

Pugliese

Kochav

et al. 2020

Preprint

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Introduction: Severely ill inpatients with SARS-CoV-2 infection, Coronavirus Disease 2019 (COVID-19) require close electrocardiographic (ECG) monitoring due to frequent cardiac involvement of the disease and cardiovascular side effects of therapies. This study aimed to compare ECG parameters measured from conventional 12-lead ECGs to those from a telemetry-generated 7-lead or single lead ECG to determine if the latter may be an alternative for screening and monitoring patients, particularly during a pandemic. Methods and Results: We identified 33 patients with respiratory failure due to COVID-19 undergoing telemetry monitoring in the intensive care unit. Each received a 12-lead ECG utilizing standard lead placement. A concurrent 7-lead ECG and single lead (lead II) tracing were obtained using the central telemetry system. Each ECG was interpreted and intervals manually measured by 2 cardiologists with disagreements adjudicated by a third. Compared to the 12-lead ECG measurement, the 7-lead ECG underestimated the corrected QT by on average 13.45±32.05 msec, and the single lead ECG underestimated corrected QT by 19.62±33.19 msec (Bazett, p < 0.05). Bland Altman analysis also demonstrated evidence of a positive bias, suggesting that the telemetry-derived tracings underestimated the QT interval. The presence of T wave abnormalities and ST segment changes were overestimated by the telemetry-derived tracings as compared to standard ECGs. Conclusion: Though telemetry-derived ECGs may be useful in screening patients for significant ECG abnormalities, they likely do not represent a reliable replacement of the standard 12-lead ECG in the routine diagnosis and management of critically ill patients.

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Section: Discussionsupporting

confidence: 88%

Derived telemetry-based electrocardiograms in the intensive care unit: insights from a COVID-19 epicenter

Coromilas

Pugliese

Kochav

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…These telemetry findings expand upon a smaller study of non-ICU patients receiving either hydroxychloroquine or azithromycin, in which no life-threatening ventricular tachyarrhythmias were detected. 8 A separate study reported a 5.9% incidence of malignant ventricular tachyarrhythmias in hospitalized patients with COVID-19, 10 but this study did not stratify arrhythmias by illness severity, and a high frequency of critical illness is suggested by the mechanical ventilation rate of 24%, thereby limiting comparison with our non-ICU telemetry findings.…”

Section: Oxygen Requirements and Cardiac Arrhythmias In Non-icu Patientsmentioning

confidence: 76%

Clinical Characteristics and Outcomes of Non-ICU Hospitalization for COVID-19 in a Nonepicenter, Centrally Monitored Healthcare System

et al. 2020

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BACKGROUND: The clinical characteristics and outcomes associated with non–intensive care unit (non-ICU) hospitalizations for coronavirus disease 2019 (COVID-19) outside disease epicenters remain poorly characterized. METHODS: Systematic analysis of all non-ICU patient hospitalizations for COVID-19 completing discharge between March 13 and May 1, 2020, in a large US health care system utilizing off-site central monitoring. Variables of interest were examined in relation to a composite event rate of death, ICU transfer, or increased oxygen requirement to high-flow nasal cannula, noninvasive ventilation, or mechanical ventilation. RESULTS: Among 350 patients (age, 64 ± 16 years; 55% male), most (73%) required 3 L/min or less of supplemental oxygen during admission. Telemetry was widely utilized (79%) yet arrhythmias were uncommon (14%) and were predominantly (90%) among patients with abnormal troponin levels or known cardiovascular disease. Ventricular tachycardia was rare (5%), nonsustained, and not associated with hydroxychloroquine/azithromycin treatment. Adverse events occurred in 62 patients (18%), including 22 deaths (6%), 48 ICU transfers (14%), and 49 patients with increased oxygen requirement (14%) and were independently associated with elevated C-reactive protein (odds ratio, 1.09 per 1 mg/dL; 95% CI, 1.01-1.18; P = .04) and lactate dehydrogenase (OR, 1.006 per 1U/L; 95% CI, 1.001-1.012; P = .03) in multivariable analysis. CONCLUSION: Among non–critically ill patients hospitalized within a nonepicenter health care system, overall survival was 94% with the development of more severe illness or death independently associated with higher levels of C-reactive protein and lactate dehydrogenase on admission. Clinical decompensation was largely respiratory-related, while serious cardiac arrhythmias were rare, which suggests that telemetry can be prioritized for high-risk patients.

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“…This combination has been associated with a higher risk of QTc prolongation, ventricular arrhythmia, TdP (with an incidence of 0.4%), atrial fibrillation, atrioventricular block, or cardiac arrest [68, 71,80,89,90]. These abnormal findings appear to be developed at day 3-4 of the treatment [80,90,91]. Rosenberg et al showed that patients treated with hydroxychloroquine alone presented a higher risk of cardiac arrest (aOR 2.97 [95% CI 1.56-5.64]) than those treated with azithromycin [71].…”

Section: Design and Locationmentioning

confidence: 99%

Azithromycin in the treatment of COVID-19: a review

Echeverría-Esnal

Martín-Ontiyuelo

Navarrete-Rouco

et al. 2020

Expert Review of Anti-infective Therapy

198

148

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Introduction: SARS-CoV-2 is a novel virus that causes coronavirus disease-19 (COVID-19). Antiviral and immunomodulatory agents have been proposed as potential treatments. Azithromycin exhibits both properties and therefore may play a role. Areas covered: This article reviews the pharmacology, pharmacokinetics, clinical efficacy, and safety of azithromycin in viral infections, with emphasis on COVID-19. A literature search of PUBMED was conducted on May 30 th and updated on July 28 th. Expert opinion: Azithromycin presents in vitro activity against SARS-CoV-2 and could act in different points of the viral cycle. Its immunomodulatory properties include the ability to downregulate cytokine production, maintain epithelial cell integrity or prevent lung fibrosis. Azithromycin use was associated with a reduction in mortality and ventilation days in other viral infections. These properties could be beneficial throughout the COVID-19. However, the evidence of its use is scarce and of low quality. Azithromycin has been assessed in retrospective observational studies mainly in combination with hydroxychloroquine, which has shown to provide no benefit. This macrolide presents a well-known safety profile. Upcoming clinical trials will determine the role of azithromycin in the COVID-19 (including the stage of the disease where it offers the greatest benefits and the effect of its combination with other drugs).

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Inpatient Use of Ambulatory Telemetry Monitors for COVID-19 Patients Treated With Hydroxychloroquine and/or Azithromycin

Cited by 62 publications

References 4 publications

Derived telemetry-based electrocardiograms in the intensive care unit: insights from a COVID-19 epicenter

Derived telemetry-based electrocardiograms in the intensive care unit: insights from a COVID-19 epicenter

Clinical Characteristics and Outcomes of Non-ICU Hospitalization for COVID-19 in a Nonepicenter, Centrally Monitored Healthcare System

Azithromycin in the treatment of COVID-19: a review

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