Sinus bradycardia is associated with poor outcome in critically ill patients with COVID-19 due to the B.1.1.7 Lineage

Chalkias, Athanasios; Pantazopoulos, Ioannis; Papagiannakis, Nikolaos; Skoulakis, Anargyros; Laou, Eleni; Kolonia, Konstantina; Ntalarizou, Nicoletta; Tourlakopoulos, Konstantinos; Pagonis, Athanasios; Kampolis, Christos; Romualdo, Luis García de Guadiana; Ragias, Dimitrios; Eugen‐Olsen, Jesper; Gourgoulianis, Konstantinos; Αrnaoutoglou, Eleni; Investigators, Sparcol

doi:10.1016/j.toxrep.2021.07.004

Cited by 6 publications

(12 citation statements)

References 28 publications

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“…One proposed mechanism is that the cytokine storm produced by severe SARS-CoV-2 infection directly affects the sinoatrial node leading to bradycardia [20]. Previous studies have also reported that bradycardia in COVID-19 patients is not associated with hypoxia, myocardial ischemia, or medications that induce bradycardia [17,18]. Our study did not find any difference in the incidence of bradycardia in young and elderly patients (p = 0.15).…”

Section: Discussioncontrasting

confidence: 60%

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Comparison of Clinical Characteristics and Outcomes of COVID-19 Between Young and Older Patients: A Multicenter, Retrospective Cohort Study

Umeh¹,

Watanabe²,

Tuscher³

et al. 2022

Cureus

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BackgroundOutcomes of coronavirus disease 2019 have been reported to be different in the young and elderly populations. However, previous studies examining these characteristics and differences in outcomes between the two groups had a small sample size. Therefore, in this study, we evaluate the differences between young and elderly patients using a large multicenter dataset. MethodologyWe conducted a retrospective study of 1,116 consecutive COVID-19 patients admitted to two hospitals in southern California in the United States between March 2020 and March 2021. In this study, we categorized patients into two age groups: less than 65 years and 65 years and above. Finally, Kaplan-Meier and backward selection Cox multivariate regression analyses were done using mortality as the dependent variable. ResultsOur analysis showed increased survival in patients aged less than 65 years compared to those aged 65 years or above (p < 0.001). Furthermore, in patients aged 65 years and above, age (hazard ratio (HR) = 1.05; p < 0.001), C-reactive protein (CRP) (HR = 1.05; p < 0.001), and bradycardia (HR = 2.1; p < 0.001) were significantly associated with mortality. Similarly, CRP (HR 1.05; p = 0.02) was significantly associated with mortality in patients aged less than 65 years. However, contrary to many studies, being male (HR = 0.46; p = 0.002) was protective against mortality in patients aged less than 65 years. ConclusionsOur study showed that the predictors of mortality in COVID-19 patients differed by age group. While age, CRP, and bradycardia were associated with mortality in those aged less than 65 years, only CRP was associated with mortality in those aged 65 years and above.

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Section: Discussioncontrasting

confidence: 60%

“…Further, unlike in the young, bradycardia was predictive of mortality in the elderly. In previous studies, bradycardia has been associated with increased mortality; however, its mechanism remains unclear [17][18][19].…”

Section: Discussionmentioning

confidence: 98%

Comparison of Clinical Characteristics and Outcomes of COVID-19 Between Young and Older Patients: A Multicenter, Retrospective Cohort Study

Umeh¹,

Watanabe²,

Tuscher³

et al. 2022

Cureus

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“…Similarly, Chalkias et al found that the onset of sinus bradycardia during their COVID-19 admission was associated with mortality in intensive care patients. [ 16 ]…”

Section: Qualitative Resultsmentioning

confidence: 99%

“…They also found that sinus bradycardia was not associated with myocardial necrosis or the use of medication that induces bradycardia. [ 16 ]…”

Section: Qualitative Resultsmentioning

confidence: 99%

“…Kumar et al and Chalkias et al used continuous cardiac monitoring to determine bradycardia in all hospitalized COVID-19 patients and patients admitted to the ICU and reported a bradycardia incidence of 24.9% and 79%, respectively. [ 10 , 16 ] Conversely, Antwi-Amoabeng et al used ECG done after COVID-19 diagnosis to determine bradycardic patients and reported an incidence of seven percent [ 10 ]. Thus, using an ECG done after the COVID-19 diagnosis will likely underestimate the incidence of sinus bradycardia in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

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Meta-analysis and systematic literature review of COVID-19 associated bradycardia as a predictor of mortality

Umeh¹,

Kumar²,

Wassel

et al. 2022

Egypt Heart J

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Background Cardiac arrhythmias have been identified as independent predictors of mortality in Coronavirus disease 2019 (COVID-19) patients. While some studies have reported poor prognosis with bradycardia in COVID-19 patients, others have not found any association between bradycardia and mortality in COVID-19 patients. This study aims to assess the relationship between bradycardia and mortality in COVID-19 patients by reviewing existing literature. Main body Articles were obtained by systematically searching the PubMed and Google scholar databases. Qualitative and quantitative analyses of the studies on bradycardia and mortality in COVID-19 were done. A pooled estimate, with a sample size of 1320 patients, comparing the effect of patients that were bradycardic during their admission with those that were not on mortality showed that bradycardia did not lead to increased mortality in COVID-19 patients (OR 1.25, 95% CI 0.41–3.84, p = 0.7). Conclusions This meta-analysis showed that bradycardia was not significantly associated with mortality in COVID-19 patients. However, this study is limited by the few studies on bradycardia and mortality in COVID-19 patients. Therefore, future studies should investigate this relationship so that clinicians can prognostically triage and treat COVID-19 patients appropriately.

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Remdesivir-induced Bradycardia is not Associated with Worse Outcome in Patients with COVID-19: A Retrospective Analysis

Pantazopoulos

Mavrovounis

Dimeas

et al. 2022

Am J Cardiovasc Drugs

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Background COVID-19, is primarily a respiratory illness but is known to cause extrapulmonary manifestations, especially on the cardiovascular system. Bradycardia is commonly reported in COVID-19 patients despite no prior history of occurrence, and many studies have shown an association with increased mortality. Multiple case reports have been published showcasing remdesivir potentially causing bradycardia. Our aim was to investigate the incidence of bradycardia in patients receiving remdesivir and examine the association with disease severity and survival outcomes. Methods A retrospective study was performed including 160 COVID-19 patients receiving remdesivir for 5 days. Patients’ demographics, comorbidities, medication, vital signs, laboratory tests and outcome were recorded. Bradycardia was defined as a heart rate < 60 beats/min and severe bradycardia < 50 beats/min. Results One hundred eighteen (73.8%) patients experienced at least one episode of bradycardia during hospitalisation. Bradycardia was present in 12 (7.5%) patients before treatment with remdesivir. The rate of bradycardia increased up to the 6th day of hospitalisation (40.6%) and subsequently diminished and normalised within 5 days after the last remdesivir dose (5% at Day 10). Severe bradycardia was observed in 13 (7.5%) patients. No difference was observed in ICU admission between groups (bradycardia vs no bradycardia). When we stratified patients according to the outcome of hospitalisation, no significant difference was observed in the occurrence of bradycardia between groups (alive vs dead) [ p = 0.853]. Conclusions Treatment with remdesivir may be associated with new-onset bradycardia in hospitalised patients with COVID-19. However, bradycardia is transient and is not associated with ICU admission and mortality.

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Sinus bradycardia is associated with poor outcome in critically ill patients with COVID-19 due to the B.1.1.7 Lineage

Cited by 6 publications

References 28 publications

Comparison of Clinical Characteristics and Outcomes of COVID-19 Between Young and Older Patients: A Multicenter, Retrospective Cohort Study

Comparison of Clinical Characteristics and Outcomes of COVID-19 Between Young and Older Patients: A Multicenter, Retrospective Cohort Study

Meta-analysis and systematic literature review of COVID-19 associated bradycardia as a predictor of mortality

Remdesivir-induced Bradycardia is not Associated with Worse Outcome in Patients with COVID-19: A Retrospective Analysis

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