Evidence map›Paper›PMID 32438018›Full record

SynthesisHeart rhythm2020

QT prolongation, torsades de pointes, and sudden death with short courses of chloroquine or hydroxychloroquine as used in COVID-19: A systematic review.

Lior Jankelson, Giorgio Karam, Matthijs L Becker, Larry A Chinitz, Meng-Chiao Tsai

Open access · bronzeAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Heart rhythm, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 104 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
104citing papers in PubMed, 10 pooled it
26.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

104 citing papers in PubMed, 10 syntheses or guidelines pooled it, 190 citations in OpenAlex.

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  20. Use of Hydroxychloroquine in Hair Disorders.Skin appendage disorders · 2023
    Article

44 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 3 countries.

Lior JankelsonNYU Langone Health, NYU School of Medicine, New York, New York. Electronic address: Lior.Jankelson@nyulangone.org.
Giorgio KaramDalhousie University, College of Pharmacy, Halifax, Nova Scotia, Canada. Electronic address: Giorgio.Karam@dal.ca.
Matthijs L BeckerPharmacy Foundation of Haarlem Hospitals, Haarlem, The Netherlands; Spaarne Gasthuis, Haarlem, The Netherlands.
Larry A ChinitzCardiac Electrophysiology and Heart Rhythm Center at NYU Langone Health, NYU School of Medicine, New York, New York.
Meng-Chiao TsaiDalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada.
Dalhousie University · CANYU Langone Health · USSpaarne Ziekenhuis · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Chloroquine and hydroxychloroquine are now being widely used for treatment of COVID-19. Both medications prolong the QT interval and accordingly may put patients at increased risk for torsades de pointes and sudden death. Published guidance documents vary in their recommendations for monitoring and managing these potential adverse effects. Accordingly, we set out to conduct a systematic review of the arrhythmogenic effect of short courses of chloroquine or hydroxychloroquine. We searched on MEDLINE and Embase, as well as in the gray literature up to April 17, 2020, for the risk of QT prolongation, torsades, ventricular arrhythmia, and sudden death with short-term chloroquine and hydroxychloroquine usage. This search resulted in 390 unique records, of which 41 were ultimately selected for qualitative synthesis and which included data on 1515 COVID-19 patients. Approximately 10% of COVID-19 patients treated with these drugs developed QT prolongation. We found evidence of ventricular arrhythmia in 2 COVID-19 patients from a group of 28 treated with high-dose chloroquine. Limitations of these results are unclear follow-up and possible publication/reporting bias, but there is compelling evidence that chloroquine and hydroxychloroquine induce significant QT-interval prolongation and potentially increase the risk of arrhythmia. Daily electrocardiographic monitoring and other risk mitigation strategies should be considered in order to prevent possible harms from what is currently an unproven therapy.

Indexed as

BetacoronavirusAntimalarialsCoronavirus InfectionsCOVID-19COVID-19 Drug TreatmentDeath, SuddenHumansHydroxychloroquineLong QT SyndromePandemicsPneumonia, ViralSARS-CoV-2Torsades de PointesAntimalarialsHydroxychloroquineArrhythmiaChloroquineCoronavirusCOVID-19HydroxychloroquineSARS-CoV-2Sudden deathTorsades de pointes

Identifiers

PMID32438018
PMCPMC7211688
OpenAlexW3022946426

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.