Frequency of Long QT in Patients with SARS-CoV-2 Infection Treated with Hydroxychloroquine: A Meta-analysis

Oscanoa, Teodoro J.; Vidal, Xavier; Kanters, Jørgen K.; Romero-Ortuño, Román

doi:10.1016/j.ijantimicag.2020.106212

Cited by 16 publications

(14 citation statements)

References 58 publications

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“…Notably very few patients received both the QTc prolonging medications hydroxychloroquine and azithromycin together. Our results are consistent with findings from recent systematic reviews and meta-analysis which report rates of 0.4% and 0.06% [ 11 , 12 ].…”

Section: Discussionsupporting

confidence: 93%

Cardiac Complications in Patients Hospitalised With COVID-19 in Australia

Bhatia¹,

Sritharan²,

Chia³

et al. 2021

Heart, Lung and Circulation

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Objectives Describe the incidence of cardiac complications in patients admitted to hospital with COVID-19 in Australia. Design Observational cohort study. Setting Twenty-one (21) Australian hospitals. Participants Consecutive patients aged ≥18 years admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Main outcome measures Incidence of cardiac complications. Results Six-hundred-and-forty-four (644) hospitalised patients (62.5±20.1 yo, 51.1% male) with COVID-19 were enrolled in the study. Overall in-hospital mortality was 14.3%. Twenty (20) (3.6%) patients developed new atrial fibrillation or flutter during admission and 9 (1.6%) patients were diagnosed with new heart failure or cardiomyopathy. Three (3) (0.5%) patients developed high grade atrioventricular (AV) block. Two (2) (0.3%) patients were clinically diagnosed with pericarditis or myopericarditis. Among the 295 (45.8%) patients with at least one troponin measurement, 99 (33.6%) had a peak troponin above the upper limit of normal (ULN). In-hospital mortality was higher in patients with raised troponin (32.3% vs 6.1%, p<0.001). New onset atrial fibrillation or flutter (6.4% vs 1.0%, p=0.001) and troponin elevation above the ULN (50.3% vs 16.4%, p<0.001) were more common in patients 65 years and older. There was no significant difference in the rate of cardiac complications between males and females. Conclusions Among patients with COVID-19 requiring hospitalisation in Australia, troponin elevation was common but clinical cardiac sequelae were uncommon. The incidence of atrial arrhythmias and troponin elevation was greatest in patients 65 years and older.

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Section: Discussionsupporting

confidence: 93%

Cardiac Complications in Patients Hospitalised With COVID-19 in Australia

Bhatia¹,

Sritharan²,

Chia³

et al. 2021

Heart, Lung and Circulation

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“…This mechanism would thus be similar to that of a widely studied investigational anti-SARS-CoV-2 agent, i.e. hydroxychloroquine, which however gave controversial results in vivo [66,67].…”

Section: Discussionmentioning

confidence: 61%

Metformin therapy and severity and mortality of SARS-CoV-2 infection: a meta-analysis

Oscanoa

Amado

Vidal³

et al. 2021

Clinical Diabetology

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background. It has been postulated that metformin could have anti-SARS-CoV-2 action. this raises the hypothesis that people who take metformin may have lower SARS-CoV-2 severity and/or mortality. Objectives. to conduct a meta-analysis of the association between the use of Metformin and risk of severity and mortality in SARS-CoV-2 infection. Methods. We searched PubMed, EMbASE, Google scholar, the Cochrane Database of Systematic Reviews and preprint servers (medRxiv and Research Square) for studies published between December 2019 and January 2021. Data was extracted on study location, year of publication, design, number of participants, sex, age at baseline, body mass index, and exposure and outcome definition. Effect statistics were pooled using random effects models with 95% confidence intervals (CI). the quality of included studies was assessed with the Newcastle-Ottawa Scale (NOS). Results. thirty-two observational studies were included, combining to a total sample of 44306 participants. the mean NOS score of included studies was 7.9. Results suggested that metformin use was associated with a reduced risk of SARS-CoV-2 mortality (OR = 0.56, 95% CI: 0.46-0.68, P < 0.001; 22 studies) but not with disease severity (OR = 0.85, 95% CI: 0.71-1.02, P = 0.077; 15 studies). In the subgroup analysis, metformin reduces the risk of mortality (OR = 0.69, 95% CI: 0.55-0.88; P = 0.002) and severity (OR = 0.83, 95% CI: 0.70-0.97, P = 0.023) in patients aged 70 and above. Conclusions. the use of metformin was associated to lower risk of mortality from SARS-CoV-2 infection. this association does not imply causation and further research is required to clarify potential mechanisms.

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“…It has been reported to prolong the QTc interval in COVID‐19 patients but to rarely cause arrhythmias. 14 As per guideline recommendations, patients received a total of 2400 mg of HCQ for 5 days in the present study. Azithromycin, a macrolide‐group antibiotic with known immunomodulatory and anti‐inflammatory effects, has been shown to reduce the viral load more when combined with HCQ for the treatment of COVID‐19.…”

Section: Discussionmentioning

confidence: 99%

Drug‐induced QTc interval prolongation in PCR‐positive non‐ICU COVID‐19 patients with diverse findings on chest computed tomography

Özyurtlu¹,

Çetin

Yavuz

2021

Int J Clin Pract

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Background Some of the drugs used for the treatment of coronavirus disease (COVID‐19) can increase the risk of corrected QT (QTc) interval prolongation, which may trigger arrhythmia or even death. Due to the low sensitivity of the reverse transcriptase‐polymerase chain reaction (RT‐PCR) test, chest computed tomography (CT) imaging is being used for COVID‐19 diagnostic correlation and to evaluate whether there is pneumonic involvement in the lung. Objective In this study, we aimed to investigate the correlation between lung changes on CT and QTc interval changes on ECG in non‐ICU patients with COVID‐19 who have a positive PCR test when using drugs that can prolong the QTc interval. Methods This was a single‐centre retrospective cohort study of hospitalized non‐ICU patients. The study included 344 patients (56.1% men) with a mean age of 46.34 ± 17.68 years. The patients were divided into four groups according to their chest CT results: those having typical, atypical, indeterminate, or no pneumonic involvement. The mean QTc intervals and heart rates calculated from electrocardiograms (ECG) during admission to the hospital and after the treatment were compared. Results No significant differences were found between the groups’ age, gender, and body mass index (BMI). In addition, no significant differences were found between the groups’ mean QTc interval values at admission ( P :.127) or after the treatment ( P :.205). The groups’ heart rate values were also similar, with no significant differences in the mean heart rate on admission ( P :.648) and post‐treatment ( P :.229) ECGs. Conclusion This study has demonstrated findings of COVID‐19 infection based on chest CT does not correlate with QT interval prolongation in non‐ICU COVID‐19 patients. There is a need for additional larger studies investigating the effect of chest CT findings on QT interval prolongation and bradycardia in COVID‐19 patients.

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Frequency of Long QT in Patients with SARS-CoV-2 Infection Treated with Hydroxychloroquine: A Meta-analysis

Cited by 16 publications

References 58 publications

Cardiac Complications in Patients Hospitalised With COVID-19 in Australia

Cardiac Complications in Patients Hospitalised With COVID-19 in Australia

Metformin therapy and severity and mortality of SARS-CoV-2 infection: a meta-analysis

Drug‐induced QTc interval prolongation in PCR‐positive non‐ICU COVID‐19 patients with diverse findings on chest computed tomography

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