[Skip to Content]

Claim CME

Cardiology

Hydroxychloroquine, Coronavirus Disease 2019, and QT Prolongation

Educational Objective
To understand the risks of QT Prolongation when prescribing hydroxychloroquine

1 Credit CME

JAMA Cardiology

Published Online: May 1, 2020

Editorial

Article Information and Disclosures

Robert O. Bonow, MD, MS^1,7;

Adrian F. Hernandez, MD, MHS^2,3,8;

Mintu Turakhia, MD, MAS^4,5,6,8

Author Affiliations

¹Northwestern University Feinberg School of Medicine, Chicago, Illinois
²Duke Clinical Research Institute, Durham, North Carolina
³Duke University, Durham, North Carolina
⁴Stanford University School of Medicine, Stanford, California
⁵Center for Digital Health, Stanford University School of Medicine, Stanford, California
⁶Veterans Affairs Palo Alto Health Care System, Palo Alto, California
⁷Editor, JAMA Cardiology
⁸Associate editor, JAMA Cardiology

Read article on JAMA Network

Read Article Claim CME

The complex decisions facing clinical teams caring for patients who are critically ill with coronavirus disease 2019 (COVID-19) are compounded by the absence of proven treatment strategies. Lacking robust trial evidence, clinicians are forced to consider all options based on preclinical and small observational studies, often in heart-wrenching settings of patients who are deteriorating in the throes of severe pneumonia, acute respiratory distress syndrome, cytokine storm, and in many cases, cardiovascular complications.

Claim CME

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Corresponding Author: Robert O. Bonow, MD, MS, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 600, Chicago, IL 60611 (robert.bonow@nm.org).

Published Online: May 1, 2020. doi:10.1001/jamacardio.2020.1782

Conflict of Interest Disclosures: Dr Hernandez reported receiving funds from the Patient-Centered Outcome Research Institute for a clinical trial of hydroxychloroquine to evaluate the efficacy of preexposure prophylaxis among health care workers. Dr Turakhia reported grants from Apple Inc and the American Heart Association and other support from AliveCor outside the submitted work. No other disclosures were reported.

References

Chen CY , Wang FL , Lin CC . Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin Toxicol (Phila). 2006;44(2):173-175. doi:10.1080/15563650500514558 PubMed Google Scholar Crossref

O’Laughlin JP , Mehta PH , Wong BC . Life threatening severe QTc prolongation in patient with systemic lupus erythematosus due to hydroxychloroquine. Case Rep Cardiol. 2016;2016:4626279. doi:10.1155/2016/4626279 PubMed Google Scholar

World Health Organization. The cardiotoxicity of antimalarials: World Health Organization Malaria Policy Advisory Committee Meeting. Published March 22, 2017. Accessed April 22, 2020. https://www.who.int/malaria/mpac/mpac-mar2017-erg-cardiotoxicity-report-session2.pdf.

Rock EP , Finkle J , Fingert HJ , et al. Assessing proarrhythmic potential of drugs when optimal studies are infeasible. Am Heart J. 2009;157(5):827-836, 836.e1. doi:10.1016/j.ahj.2009.02.020 PubMed Google Scholar Crossref

Ray WA , Murray KT , Hall K , Arbogast PG , Stein CM . Azithromycin and the risk of cardiovascular death. N Engl J Med. 2012;366(20):1881-1890. doi:10.1056/NEJMoa1003833 PubMed Google Scholar Crossref

Drew BJ , Ackerman MJ , Funk M , et al; American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the American College of Cardiology Foundation. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation. 2010;121(8):1047-1060. doi:10.1161/CIRCULATIONAHA.109.192704 PubMed Google Scholar Crossref

Roden DM , Harrington RA , Poppas A , Russo AM . Considerations for drug interactions on QTc in exploratory COVID-19 (coronavirus disease 2019) treatment. Circulation. Published online April 8, 2020. doi:10.1161/CIRCULATIONAHA.120.047521 PubMed Google Scholar

Bessière F , Roccia H , Delinière A , et al. Assessment of QT intervals in a case series of patients with coronavirus disease 2019 (COVID-19) infection treated with hydroxychloroquine alone or in combination with azithromycin in an intensive care unit. JAMA Cardiol. Published online May 1, 2020. doi:10.1001/jamacardio.2020.1787 Google Scholar

Mercuro NJ , Yen CF , Shim DJ , et al. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease 2019 (COVID-19). JAMA Cardiol. Published online May 1, 2020. doi:10.1001/jamacardio.2020.1834 Google Scholar

Borba MGS , Val FFA , Sampaio VS , et al. Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a randomized clinical trial. JAMA Netw Open. 2020;3(4.23):e208857. doi:10.1001/jamanetworkopen.2020.8857 Google Scholar

US Food and Drug Administration. Drug safety communication: FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems, close supervision is strongly recommended: safety announcement. Published April 24, 2020. Accessed April 24, 2020. https://www.fda.gov/media/137250/download

ClinicalTrials.gov. Outcomes related to covid-19 treated with hydroxychloroquine among in-patients with symptomatic disease (ORCHID). Published April 3, 2020. Accessed April 22, 2020. https://clinicaltrials.gov/ct2/show/NCT04332991

International Standard Randomised Controlled Trials Number Registry. A randomised trial of treatments to prevent death in patients hospitalised with COVID-19 (coronavirus). Published 2020. Accessed April 22, 2020. http://www.isrctn.com/ISRCTN50189673

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.