Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Bradycardia (heart rate (HR) <60bpm) was not initially described as an adverse effect associated with remdesivir but has been reported after its approval. Data regarding remdesivir-associated bradycardia is limited and conflicting.
Research Question or Hypothesis: Is remdesivir associated with heart rate (HR) reduction and/or bradycardia?
Study Design: Single-center, retrospective cohort study between 5/1/2020-12/1/2021.
Methods: Hospitalized patients eligible for inclusion were =18 years old and received >24 hours of remdesivir. Patients were excluded if HR<60 or >110 beats per minute (bpm) within 24 hours of starting remdesivir or received a bradycardia-associated medication that was not a home/chronic medication within 24 hours or up to 5 days after starting remdesivir. The primary outcome was the difference in median HR pre- and post-remdesivir. Secondary outcomes included number of episodes of bradycardia post-remdesivir, nadir HR, and interventions to manage bradycardia (atropine administration, pacing, and/or transfer to intensive care unit). The Wilcoxon signed-rank test was used for continuous data. Variables to assess post-remdesivir bradycardia were considered in the multivariate logistic regression if they had a p<0.1 on univariate analysis.
Results: Among 514 unique patient encounters, 328 were included. Most patients were male (53.4%), had severe COVID-19 (59.8%), and median (IQR) age was 62 (23.7) years. Median (IQR) remdesivir duration was 4.9 (1.5) days. Median (IQR) HR (bpm) was significantly lower post-remdesivir compared to pre-remdesivir (74 (15) versus 87 (19), p<0.001). Among 48.8% of patients with bradycardia post-remdesivir, median (IQR) nadir HR (bpm) was 53 (6.8). No patients required an intervention for remdesivir-associated bradycardia. In multivariate logistic regression, remdesivir duration (OR 1.26(95% CI 1.04-1.54), p=0.019) and median pre-remdesivir HR (OR 0.96(95% CI 0.94-0.97), p<0.001) were identified as significant predictors for post-remdesivir bradycardia.
Conclusion: A statistically significant reduction in median HR post-remdesivir was observed with several patients experiencing bradycardia; however, none required intervention. Longer remdesivir durations and lower pre-remdesivir HR were predictors of post-remdesivir bradycardia.
Presenting Author
Zoey Zagoria PharmD CandidateBinghamton University
Authors
Wesley Kufel PharmD
Binghamton University School of Pharmacy and Pharmaceutical Sciences
Nabil Zeineddine M.D.
State University of New York Upstate Medical University
Robert Seabury PharmD
State University of New York Upstate Medical University
Jeffrey Steele PharmD
State University of New York Upstate University Hospital