Author + information
- Thomas F. O’Connell, MD1,∗,
- Christopher J. Bradley, DO1,∗,
- Amr E. Abbas, MD1,
- Brian D. Williamson, MD1,
- Akash Rusia, MD1,
- Adam M. Tawney, MD1,
- Rick Gaines, MD1,
- Jason Schott, DO1,
- Alex Dmitrienko, PhD2 and
- David E. Haines, MD1,# ()
- 1From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, Michigan
- 2Mediana Inc, Medford, Massachusetts
- ↵#Address for correspondence: David E. Haines, MD Department of Cardiovascular Medicine Beaumont Hospital 3601 West 13 Mile Road Royal Oak, MI 48073 T: 248-898-4176
Background Hydroxychloroquine and azithromycin (HCQ/AZM) are being widely used to treat COVID-19 despite the known risk of QT interval prolongation and unknown risk of arrhythmogenesis in this population.
Objective The study aimed to characterize corrected QT (QTc) prolongation in a cohort of hospitalized COVID-19 patients treated with combination HCQ/AZM.
Methods A retrospective cohort of COVID-19 hospitalized patients treated with HCQ/AZM was reviewed. The QTc interval was calculated prior to drug administration and for the first 5 days following initiation. The primary end point 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 receiving concomitant HCQ/AZM, the mean QTc increased from 443±25 msec to a maximum of 473±40 msec (87 (21%) had a QTc ≥500 msec). Factors associated with QTc prolongation ≥500 msec 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 where 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 COVID-19 patients treated with HCQ/AZM. Several clinical factors were associated with greater QTc prolongation. Changes in QTc were not associated with increased risk of death.
↵∗ Drs. O’Connell and Bradley contributed equally to this article and are co-first authors
Drs. O’Connell, Bradley, Abbas, Williamson, Rusia, Tawney, Gaines and Schott have no disclosures. Dr. Dmitrienko is employed by Mediana, Inc. Dr. Haines has received honoraria from Biosense Webster, Farapulse and Sagentia, and is a consultant for Affera, Boston Scientific, Integer, Medtronic, Philips Healthcare and Zoll corporations.
Acknowledgements: The authors would like to thank Shirley Qu and Connie Gaines for their hard work and expertise helping to assemble and organize the database.
- Received May 22, 2020.
- Revision received July 29, 2020.
- Accepted July 30, 2020.