Cardiac Complications Attributed to Hydroxychloroquine: A systematic review of the Literature Pre-COVID-19
Fram G, Wang DD, Malette K, Villablanca P, Kang G, So K, Basir MB, Khan A, McKinnon JE, Zervos M, and O'Neill WW. Cardiac Complications Attributed to Hydroxychloroquine: A systematic review of the Literature Pre-COVID-19. Curr Cardiol Rev 2020.
Curr Cardiol Rev
INTRODUCTION: Hydroxychloroquine has been used for rheumatological diseases for many decades and is considered a safe medication. With the COVID-19 outbreak, there has been an increase in reports associating cardiotoxicity with hydroxychloroquine. It is unclear if cardiotoxic profile of hydroxychloroquine is previously underreported in the literature, or a new manifestation of COVID-19 and therapeutic interventions. This manuscript evaluates the incidence of cardiotoxicity associated with hydroxychloroquine prior to onset of COVID-19.
METHODS: PubMED, EMBASE, and Cochrane databases were searched for keywords derived from MeSH terms, prior to 4/9/2020. Inclusion eligibility was based on appropriate reporting of cardiac conditions and study design.
RESULTS: Sixty-nine articles were identified (58 case reports, 11 case series). Majority (84%) of patients were female, with a median age of 49.2(range 16-92) years. Fifteen of 185 patients with cardiotoxic events were in the setting of acute intentional overdose. In acute overdose, the median ingestion was 17,857 14,873 mg. Two of 15 patients died after acute intoxication. In patients with long-term hydroxychloroquine use (10.5 ± 8.9 years), new onset systolic heart failure occurred in 54 of 155 patients (35%) with median cumulative ingestion of 1,493,800 ± 995,517 mg. The majority of patients improved with withdrawal of hydroxychloroquine and standard therapy.
CONCLUSIONS: Millions of hydroxychloroquine doses are prescribed annually. Prior to COVID-19 pandemic, cardiac complications attributed to hydroxychloroquine were uncommon. Further studies are needed to understand the impact of COVID-19 on the cardiovascular system to understand presence or absence of potential medication interactions with hydroxychloroquine in this new pathophysiological state.
ePub ahead of print