Abstract
Objectives
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).
Background
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.
Methods
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.
Results
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 < 0.001), body mass index <30 kg/m2 (p = 0.005), heart failure (p < 0.001), elevated creatinine (p = 0.005), and peak troponin (p < 0.001). The change in QTc was not associated with death over the short period of the study in a population in which mortality was already high (hazard ratio: 0.998; p = 0.607). No primary high-grade ventricular arrhythmias were observed.
Conclusions
An increase in QTc was seen in hospitalized patients with COVID-19 treated with HCQ/AZM. Several clinical factors were associated with greater QTc prolongation. Changes in QTc were not associated with increased risk of death.
【저자키워드】 COVID-19, Azithromycin, Hydroxychloroquine, QT prolongation, torsades de pointes, 【초록키워드】 coronavirus, Mortality, risk, arrhythmia, heart failure, Cohort, body mass index, Patient, death, age, incidence, QT interval, change, QTc, QTC prolongation, creatinine, primary endpoint, Tachycardia, QTc interval, Factor, Endpoint, increased risk, all-cause mortality, Drug administration, treat, retrospective cohort, objective, secondary, Result, greater, elevated, treated, calculated, hospitalized patient, magnitude, increase in, sustained, the mean, clinical factor, ventricular, with COVID-19, 【제목키워드】 prolongation,