https://doi.org/10.4081/gc.2021.9536

Proarrhythmia assessment in treatment with hydroxychloroquine and azithromycin hospitalized elderly COVID-19 patients - our experience

Vol. 7 No. 2 (2021)
Submitted: 28 November 2020
Accepted: 9 March 2021
Published: 18 June 2021
QT assessment, hydroxychloroquine, azithromycin, COVID-19.
Abstract Views: 446
PDF: 295
HTML: 8
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Raffaele Costa
Geriatric Unit, ‘Pugliese-Ciaccio’ General Hospital, Catanzaro, Italy.
Alberto Castagna
albertocastagna@tiscali.it
Primary Care Department, Azienda Sanitaria Provinciale di Catanzaro, Italy.
Carlo Torchia
Geriatric Unit, ‘Pugliese-Ciaccio’ General Hospital, Catanzaro, Italy.
Carmen Ruberto
Geriatric Unit, ‘Pugliese-Ciaccio’ General Hospital, Catanzaro, Italy.
Viviana Vespertini
Infectious Diseases Unit, ‘Pugliese-Ciaccio’ General Hospital, Catanzaro, Italy.
Lucio Cosco
Infectious Diseases Unit, ‘Pugliese-Ciaccio’ General Hospital, Catanzaro, Italy.
Giovanni Ruotolo
Geriatric Unit, ‘Pugliese-Ciaccio’ General Hospital, Catanzaro, Italy.

The aim of our study was to characterize the repolarization disorders propensity induced by drug-drug interaction. In this observational retrospective study, we report our experience on all elderly patients with ascertained diagnosis of coronavirus disease 2019 through nasopharyngeal swab with real time-polymerase chain reaction at our Pugliese-Ciaccio hospital in Catanzaro, who received hydroxychloroquine (HCQ), with or without azithromycin (AZY). 33 hospitalized patients were examined. We calculated QT value, cQT, QT dispersion, and cQT dispersion and examined possible progression on the basal electrocardiogram (T0) and after the insertion of the drug (T1). The QT value is increased by T0 vs T1 (370±40.74 vs 420±36.91 ms; P=0.000), as well as the cQT value (408±25.40 vs 451.54±58.81; P=0.003), the QT dispersion (QTd: 36.36±14.53 vs 50.90±13.12 ms; P=0.000); the dispersion of cQTc (cQTd 46.27±18.72 vs 63.18±21.93 ms; P=0.001). The ΔQT was 37.44±44.09 while the ΔcQT was 32.01±56.47). The main determinant of QTc prolongation is the number of drug at risk of prolongation of the QT that could influence the ventricular repolarization phase. The use of HCQ in combination with AZY, in patients suffering from severe acute respiratory syndrome-related coronavirus-2, can favor the onset of serious side effects, even potentially fatal. Finally, the measures of QTd and cQTd confirmed additional electrocardiographic parameters useful in identifying patients being treated with drugs at risk of potential adverse arrhythmic events following drug interaction.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Gautret P, Lagier JC, Parola P, et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow-up: one pilot observational study. Travel Med Infect Dis. 2020:101663. [Epub ahead of print]. DOI: https://doi.org/10.1016/j.tmaid.2020.101663
Castagna A, Vetta F, Attisani G, et al. Hydroxychloroquine and QTc: beyond COVID-19; Geriatric Care 2020;6:9064. DOI: https://doi.org/10.4081/gc.2020.9064
Savarino A, Boelaert JR, Cassone A, et al. Effects of chloroquine on viral infections: an old drug against todays diseases. Lancet Infect Dis 2003;3:722-7. DOI: https://doi.org/10.1016/S1473-3099(03)00806-5
Jung H, Bobba R, Su J, et al. The protective effect of antimalarial drugs on thrombo-vascular events in systemic lupus erythematosus. Arthrit Rheum 2010;62:863-8. DOI: https://doi.org/10.1002/art.27289
Chen CY,Wang FL, Lin CC. Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin Toxicol (Phila). 2006;44:173-5. DOI: https://doi.org/10.1080/15563650500514558
O’Laughlin JP, Mehta PH,Wong BC. Life threatening severe QTc prolongation in patient with systemic lupus erythematosus due to hydroxychloroquine. Case Rep Cardiol 2016;2016:4626279. DOI: https://doi.org/10.1155/2016/4626279
World Health Organization. The cardiotoxicity of antimalarials. Geneva: World Health Organization Malaria Policy Advisory Committee Meeting; March 22, 2017. Available from: https://www.who.int/malaria/mpac/mpac-mar2017-erg-cardiotoxicity-report-session2.pdf Accessed: 22 April, 2020.
Tran DH, Sugamata R, Hirose T, et al. Azithromycin, a 15-membered macrolide antibiotic, inhibits influenza A(H1N1)pdm09 virus infection by interfering with virus internalization process. J Antibiot 2019;72:759-68. DOI: https://doi.org/10.1038/s41429-019-0204-x
Andreani J, Bideau ML, Duflot I, et al. In vitro testing of combined hydroxychloroquine and azithromycin on SARS-CoV-2 shows synergistic effect. Microb Pathog 2020;145:104228. DOI: https://doi.org/10.1016/j.micpath.2020.104228
Food and Drug Administration (FDA). FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems; June 15, 2020 Update. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or
Cenderello G, Dini S, Ziliani S, et al. COVID-19 treatment in the older people: a brief clinical review. Geriatric Care 2020;6:9330. DOI: https://doi.org/10.4081/gc.2020.9330
Charbit B, Alvarez JC, Dasque E, et al. Droperidol and ondansetron-induced QT interval prolongation: a clinical drug interaction study. Anesthesiology 2008;109:206-12. DOI: https://doi.org/10.1097/ALN.0b013e31817fd8c8
Tisdale JE, Wroblewski HA, Overholser BR, et al. Prevalence of QT interval prolongation in patients admitted to cardiac care units and frequency of subsequent administration of QT interval-prolonging drugs. A prospective, observational study in a large urban academic medical center in the US. Drug Saf 2012;35:459-70. DOI: https://doi.org/10.2165/11598160-000000000-00000
Costa R, Castagna A, Torchia C, et al. COVID-19 and cardiovascular disease in elederly patients: a challenge in the challenge. Geriatric Care 2020;6:9121. DOI: https://doi.org/10.4081/gc.2020.9121
Warren-Gash C, Blackburn R, Whitaker H, et al. Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked. Eur Respir J 2018;51:1701794. DOI: https://doi.org/10.1183/13993003.01794-2017
Bodini G, Demarzo MG, Casagrande E, et al. Concerns related to COVID-19 pandemic among patients with inflammatory bowel disease, and its influence on patients management. Eur J Clin Invest 2020;e13233. [Epub ahead of print]. DOI: https://doi.org/10.1111/eci.13233
Bessière F, Roccia H, Delinière A, et al. Assessment of QT Intervals in a case series of patients with coronavirus disease 2019 (COVID-19) infection treated with hydroxychloroquine alone or in combination with azithromycin in an intensive care unit. JAMA Cardiol 2020:1787. [Epub ahead of print]. DOI: https://doi.org/10.1001/jamacardio.2020.1787
Mercuro NJ, Yen CF, Shim DJ, et al. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus 2019 (COVID-19) infection. JAMA Cardiol 2020:1834. [Epub ahead of print]. DOI: https://doi.org/10.1001/jamacardio.2020.1834
Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000;36:6. DOI: https://doi.org/10.1016/S0735-1097(00)00962-1
Drew BJ, Ackerman MJ, Funk M, et al.; on behalf of the American heart Association Acute Cardiac care Committee of the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the American College of Cardiology Foundation. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol 2010;55:934-47. DOI: https://doi.org/10.1016/j.jacc.2010.01.001
Mahévas M, Tran VT, Roumier M, et al. Clinical efficacy of hydroxychloroquine in patients with COVID-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ 2020;369:m1844.
Geleris J, Sun Y, Platt J, et al. Observational study of hydroxychloroquine in hospitalized patients with covid-19. N Engl J Med 2020;382:2411-8. DOI: https://doi.org/10.1056/NEJMoa2012410

How to Cite

Costa, R., Castagna, A., Torchia, C., Ruberto, C., Vespertini, V., Cosco, L., & Ruotolo, G. (2021). Proarrhythmia assessment in treatment with hydroxychloroquine and azithromycin hospitalized elderly COVID-19 patients - our experience. Geriatric Care, 7(2). https://doi.org/10.4081/gc.2021.9536

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.


Similar Articles

You may also start an advanced similarity search for this article.