Cardiac Complications Attributed to Hydroxychloroquine: A Systematic Review of the Literature Pre-COVID-19

(E-pub Ahead of Print)

Author(s): Georgi Fram, Dee Dee Wang*, Kelly Malette, Pedro Villablanca, Guson Kang, Kent So, Mir B. Basir, Arfaat Khan, John E. McKinnon, Marcus Zervos, William W. O’Neill

Journal Name: Current Cardiology Reviews

Become EABM
Become Reviewer

Abstract:

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.

Keywords: Clinical cardiology, hydroxychloroquine, infectious disease, covid-19, cardiac complications, SLE.

open access plus

Rights & PermissionsPrintExport Cite as

Article Details

(E-pub Ahead of Print)
DOI: 10.2174/1573403X16666201014144022

Article Metrics

PDF: 7