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. 2022 Nov;22(6):705-710.
doi: 10.1007/s40256-022-00547-4. Epub 2022 Aug 25.

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

Ioannis Pantazopoulos  1 , Georgios Mavrovounis  2 , Georgios Dimeas  2 , Nikolaos Zikos  2 , Maria Pitsikou  3 , Eleni Rousogianni  2 , Maria Mermiri  4 , Anastasia Michou  4 , Michalis Spanos  2 , Christos Maniotis  5 , Athanasios Chalkias  4 , Eleni Laou  4 , Georgios Zakynthinos  6 , Dimitrios Chatzis  7 , Konstantinos Gourgoulianis  3
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Remdesivir-induced Bradycardia is not Associated with Worse Outcome in Patients with COVID-19: A Retrospective Analysis

Ioannis Pantazopoulos et al. Am J Cardiovasc Drugs. 2022 Nov.

Abstract

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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Conflict of interest statement

Ioannis Pantazopoulos, Georgios Mavrovounis, Georgios Dimeas, Nikolaos Zikos, Maria Pitsikou, Eleni Rousogianni, Maria Mermiri, Anastasia Michou, Michalis Spanos, Christos Maniotis, Athanasios Chalkias, Eleni Laou, Georgios Zakynthinos, Dimitrios Chatzis and Konstantinos Gourgoulianis declare that they have no potential conflict of interest that might be relevant to this work.

Figures

Fig. 1
Fig. 1
Rate of bradycardia occurrence in patients receiving remdesivir (black) until Day 10 of hospital stay. Grey columns indicate patients who were not under chronic use of antiarrhythmic drugs
Fig. 2
Fig. 2
Kaplan-Meier curves showing cumulative survival according to the presence of bradycardia
See this image and copyright information in PMC

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