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Mitigating arrhythmia risk in Hydroxychloroquine and Azithromycin treated COVID-19 patients using arrhythmia risk
Kazimieras Maneikis1,2, Ugne Ringeleviciute1,2, Justinas Bacevicius2,3
1Hematology, Oncology and Transfusion Medicine Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
Insights
Cardiac safety was assessed in COVID-19 patients receiving Hydroxychloroquine and Azithromycin. The study found a low incidence of QTc prolongation and no ventricular tachycardia events, indicating good cardiac safety with risk management.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- The combination of Hydroxychloroquine and Azithromycin was investigated for COVID-19 treatment.
- Cardiac safety is a critical consideration for this drug combination.
Purpose of the Study:
- To evaluate the cardiac safety of Hydroxychloroquine and Azithromycin in COVID-19 patients.
- To assess arrhythmia risk using a management plan.
Main Methods:
- Retrospective analysis of 81 COVID-19 patients treated with Hydroxychloroquine and Azithromycin.
- Monitoring for QTc interval prolongation and ventricular tachycardia.
- Statistical analysis using R, with p<0.05 considered significant.
Main Results:
- 17.3% of patients experienced QTc ≥ 480 ms; 8.6% had QTc prolongation ≥ 500 ms.
- No cases of ventricular tachycardia were observed.
- Hypokalemia and diuretic use were risk factors for QTc prolongation ≥ 500 ms.
Conclusions:
- The combination of Hydroxychloroquine and Azithromycin showed a low incidence of significant QTc prolongation in COVID-19 patients.
- No cardiac arrhythmia events, including ventricular tachycardia, were recorded when using a cardiac arrhythmia risk management plan.
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.
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