Mitigating arrhythmia risk in Hydroxychloroquine and Azithromycin treated COVID-19 patients using arrhythmia risk management plan

Abstract

Aims To assess cardiac safety in COVID-19 patients treated with the combination of Hydroxychloroquine and Azithromycin using arrhythmia risk management plan. Methods and results We retrospectively examined arrhythmia safety of treatment with Hydroxychloroquine and Azithromycin in the setting of pre-defined arrhythmia risk management plan. The data was analyzed using R statistical package version 4.0.0. A two-tailed p-value<0.05 was considered significant. 81 patients were included from March 23rd to May 10th 2020. The median age was 59 years, 58.0% were female. The majority of the study population (82.7%) had comorbidities, 98.8% had radiological signs of pneumonia. Fourteen patients (17.3%) experienced QTc ≥ 480 ms and 16 patients (19.8%) had an increase of QTc ≥ 60 ms. Seven patients (8.6%) had QTc prolongation of ≥ 500 ms. The treatment was discontinued in 4 patients (4.9%). None of the patients developed ventricular tachycardia. The risk factors significantly associated with QTc ≥ 500 ms were hypokalemia (p = 0.032) and use of diuretics during the treatment (p = 0.020). Three patients (3.7%) died, the cause of death was bacterial superinfection with septic shock in two patients, and disseminated intravascular coagulation with multiple organ failure in one patient. None of these deaths were associated with cardiac arrhythmias. Conclusion We recorded a low incidence of QTc prolongation ≥ 500 ms and no ventricular tachycardia events in COVID-19 patients treated with Hydroxychloroquine and Azithromycin using cardiac arrhythmia risk management plan.

Clinical and electrocardiographic outcomes evaluated by telemedicine of outpatients with clinical suspicion of COVID-19 treated with chloroquine compounds in Brazil†

“…Despite the challenges for the acquisition of longitudinal electrocardiographic data in a nationwide study carried out by a public telemedicine network, this finding is in agreement with most studies published so far ( 36 ). Despite the potential risk of cardiac arrhythmias associated with antimalarial drugs, in addition to the cardiac involvement in severe COVID-19 and the preliminary case reports of potentially fatal arrhythmias in patients with the disease ( 37 ), studies with chloroquine in both hospital and outpatient settings have not consistently shown an increase in major ECG changes, despite the myriad of incident side effects in the treatment groups ( 36 , 38 ). Data heterogeneity should also be considered for this analysis, especially about the timing of the baseline ECG versus the peak incidence of electrocardiographic outcomes following chloroquine administration (first 72 h) and the considerable loss of electrocardiographic follow-up.…”