Short Term Use Of Hydroxychloroquine Not Linked To Lethal He
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Short-term hydroxychloroquine treatment is not associated with lethal heart rhythms in patients with COVID-19 who are risk assessed prior to receiving the drug. That’s the finding of research published in EP Europace, a journal of the European Society of Cardiology (ESC).

“This was the largest study to assess the risk of dangerous heart rhythms (arrhythmias) in COVID-19 patients treated with hydroxychloroquine,” said researchers. “In the cohort, there was a low rate of arrhythmias and none were associated with hydroxychloroquine.”

The study began when there was very little experience using hydroxychloroquine to treat patients with COVID-19. Current evidence suggests that it is ineffective in patients with advanced disease but there is debate around its effectiveness in the early phase. This study was not designed to test the effectiveness of hydroxychloroquine in COVID-19 but rather to examine cardiac safety.

Hydroxychloroquine is known to cause an electrical change in the heart in some patients. It is called QT prolongation because of the pattern on the electrocardiogram (ECG). This electrical pattern is linked with an increased risk of deadly heart rhythms.

This study was conducted to assess ECG changes and arrhythmias in COVID-19 patients treated with hydroxychloroquine in different clinical settings. A total of 649 COVID-19 patients were enrolled from seven institutions, the average age was 62 years and 46% were men. A risk calculator was used to assess the likelihood of QT prolongation and decide the treatment setting. All patients had an ECG before starting treatment and at least one follow-up measurement.

In all centres, patients took 200 mg hydroxychloroquine twice a day. More than half of patients (58.6%) took a loading dose on the first day, meaning they received 400 mg twice on that day.

Hydroxychloroquine was administered early after symptom onset in three different care settings: 126 (19.4%) patients were managed at home, 495 (76.3%) were hospitalized in a medical ward, and 28 (4.3%) patients were treated in ICU. In line with real-world practice, 30% of patients received two QT-prolonging drugs, and 13.6% received three (including hydroxychloroquine).

A significant QT interval prolongation was observed in the overall cohort, but the magnitude of the increase was modest and similar across care settings. The most important determinants of QT prolongation during hydroxychloroquine treatment were fever at admission and baseline QT length.

Over a median follow-up of 16 days, there were no lethal arrhythmias. A total of seven patients (1.1%) had a serious ventricular arrhythmia, but none were deemed related to QT prolongation or to hydroxychloroquine treatment.

Researchers said: “Hydroxychloroquine treatment was associated with QT prolongation, as expected, but the change was small. There was no connection between the drug and the occurrence of arrhythmias. The study shows that hydroxychloroquine administration, alone or in combination with other potentially QT-prolonging drugs, is safe for short-term treatment of COVID-19 patients at home or in hospital, provided that they undergo risk assessment and ECG monitoring by a physician.”