Key result
Treatment with hydroxychloroquine, azithromycin, and/or antiretrovirals in not critically ill COVID-19 patients led to a significant but clinically modest increase in median QTc interval from 416 ms to 423 ms, with only 4 patients developing a QTc > 500 ms.
Why the study?
Empirical therapies for COVID-19 such as hydroxychloroquine, azithromycin, and protease inhibitors carry reported risks of QTc prolongation, but QT behavior had not been evaluated in not critically ill, unmonitored patients.
Does empirical therapy with hydroxychloroquine, azithromycin, and/or antiretrovirals cause clinically relevant QT interval prolongation in non-critically ill COVID-19 patients?
Cross-Sectional (n=219)
No
Does empirical therapy with hydroxychloroquine, azithromycin, and/or antiretrovirals cause clinically relevant QT interval prolongation in non-critically ill COVID-19 patients?
Absolute Event Rate: 423% vs 416%
p-value: p=<0.001
Empirical treatment with hydroxychloroquine, azithromycin, and/or antiretrovirals in non-critically ill COVID-19 patients causes a statistically significant but clinically non-relevant prolongation of the QT interval.
Modest QTc rise with rare marked prolongation was associated with these agents; leaves open whether routine monitoring can be de-escalated in non-critically ill patients.
SARS-CoV-2 is a rapidly evolving pandemic causing great morbimortality. Medical therapy with hydroxicloroquine, azitromycin and protease inhibitors is being empirically used, with reported data of QTc interval prolongation. Our aim is to assess QT interval behaviour in a not critically ill and not monitored cohort of patients. We evaluated admitted and ambulatory patients with COVID-19 patients with 12 lead electrocardiogram at 48 h after treatment initiation. Other clinical and analytical variables were collected. Statistical analysis was performed to assess the magnitude of the QT interval prolongation under treatment and to identify clinical, analytical and electrocardiographic risk markers of QT prolongation independent predictors. We included 219 patients (mean age of 63.6 ± 17.4 years, 48.9% were women and 16.4% were outpatients. The median baseline QTc was 416 ms (IQR 404-433), and after treatment QTc was prolonged to 423 ms (405-438) (P < 0.001), with an average increase of 1.8%. Most of the patients presented a normal QTc under treatment, with only 31 cases (14.1%) showing a QTc interval > 460 ms, and just one case with QTc > 500 ms. Advanced age, longer QTc basal at the basal ECG and lower potassium levels were independent predictors of QTc interval prolongation. Ambulatory and not critically ill patients with COVID-19 treated with hydroxychloroquine, azithromycin and/or antiretrovirals develop a significant, but not relevant, QT interval prolongation.
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Jiménez‐Jáimez et al. (2020) conducted a cross-sectional in COVID-19 (n=219). Hydroxychloroquine, azithromycin, and/or antiretrovirals vs. Baseline (pre-treatment) was evaluated on Median QTc interval (p=<0.001). Treatment with hydroxychloroquine, azithromycin, and/or antiretrovirals in not critically ill COVID-19 patients led to a significant but clinically modest increase in median QTc interval from 416 ms to 423 ms, with only 4 patients developing a QTc > 500 ms.
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