Bradycardia and Heart Rate Fluctuation Are Associated with a Prolonged Intensive Care Unit Stay in Patients with Severe COVID-19

Abstract

Background and Objective: Bradycardia has been observed among patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is suspected to be associated with poorer outcomes. Heart rate (HR) fluctuation has been found to be correlated with a greater mortality rate in critically ill patients. The association of bradycardia and HR fluctuation with the outcome of severe coronavirus disease 2019 (COVID-19) patients has not been clarified. Therefore, we aimed to examine whether bradycardia and HR fluctuation correlated with poor outcomes in patients with severe COVID-19. Materials and Methods: We conducted a secondary analysis from a prospective data collection of patients admitted to the intensive care unit, between April and June 2021, at Chiang Mai University Hospital. Results: The results showed that 62 of 86 patients (72.1%) had bradycardia, defined by HR < 60 beats per minute (bpm). The number of patients with high HR fluctuation, defined as the difference in HR during admission ≥ 40 bpm, was greater among the bradycardia group than in the non-bradycardia group (70.9% vs. 14.7%, p = 0.015, respectively). The patients with bradycardia had greater levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). In addition, a greater proportion of patients with bradycardia received interleukin-6 inhibitors and hemoperfusion as a rescue therapy than those with non-bradycardia. After adjusting for age, gender, body mass index, CRP, and mechanical ventilator; bradycardia and the high HR fluctuation were significantly associated with a longer length of stay in the intensive care unit (ICU-LOS), with adjusted risk ratios of 2.67, 95% CI; 1.02, 6.94, p = 0.045 and 2.88, 95% CI; 1.22, 6.78, p = 0.016, respectively. Conclusion: We found that bradycardia and a high heart rate fluctuation were associated with a poorer ICU outcome in terms of longer ICU-LOS among the patients with severe COVID-19.

Incidence and potential risk factors for remdesivir-associated bradycardia in hospitalized patients with COVID-19: A retrospective cohort study

“…Critical illness with SARS-CoV-2 is associated with poor outcomes and a high mortality rate because critical illness disturbs multiple organ systems including the heart function which makes patients on remdesivir therapy more vulnerable to bradycardia ( Dessie and Zewotir, 2021 ; Gao et al, 2021 ). A study by Tajarernmuang et al ( Tajarernmuang et al, 2022 ) evaluated bradycardia and heart rate fluctuation in critically ill COVID-19 patients, and they found 71.1% (62/86) of the patient had bradycardia and those patients had longer intensive care unit length of stay.…”

Factors affecting the first 24-hour mortality of patients receiving emergency medical service (EMS) in a sub-urban area: a retrospective cohort study

“…Moreover, previous studies have also shown a correlation between rapid pulse (arrhythmia) and increased mortality. [36][37][38][39][40][41] Zhang et al found that a rapid resting pulse rate increases the risk of all-cause mortality by 6% and cardiovascular mortality by 8%. This increase in mortality is believed to be caused by an imbalance between the vagus nerve, the sympathetic nervous system, and the autonomic nervous system, which leads to a rapid pulse.…”