Low hospitalization rate without severe arrhythmias: a prospective survey on 350 patients early home treated with hydroxychloroquine during COVID-19 pandemic

Abstract: Research letter Low hospitalization rate without severe arrhythmias: a prospective survey on 350 patients early home treated with hydroxychloroquine during COVID-19 pandemic Alessandro Capuccia, Andrea Santarellib, Melchiside Bartolomeic, Corrado Paolizzic, Carlo Biagettid, Antonella Dappozzoc and Giancarlo Piovaccarib J Cardiovasc Med 2020, 21:922–923 a Specialization School of Cardiology, Università Politecnica delle Marche, Ancona, bCardiovascular Department, cPrimary Care Department and dInfectious Disease Unit of Rimini, AUSL Romagna, Rimini, Italy Correspondence to Andrea Santarelli, MD, Cardiovascular Department, AUSL Romagna, Rimini, Italy E-mail: santarelliandrea62@gmail.com Received 9 May 2020 Revised 8 June 2020 Accepted 17 June 2020 To the Editor Hydroxychloroquine (HCL) alone or/and azithromycin has been shown to be effective to avoid further unfavourable clinical evolutions in coronarovirus disease-2019 (COVID-19) diseased patients particularly when administered early at home.1 The rationale is to block the inflammatory process development that is the main cause of serious coronavirus body damage through an antiphospholipid antibodies reduction.2 Methods General practitioners (GP) in Rimini, an Italian country with more than 2000 COVID-19 cases and over 500 hospitalizations, were invited prospectively by the Primary Care Department to treat all patients with a framework of recent fever more than 37.58 and at least two of the following: symptoms of cooling, cough, anosmia, tachipnea (>22/min), marked asthenia together with high resting heart rate (>90/min) with HCL therapy at home (400 mg twice a day on the 1st and 200 mg twice a day from 2nd to 6th days). Therapy was started without waiting for nasopharyngeal swab results. GPs, according to clinical judgement, were allowed to add azithromycin 500 mg/day. After 1 month (April 2020) there was a GP call to assess their protocol adherence and to respond to the survey questions; 110 doctors (about 130 000 assisted patients) actively participated. Questions asked were about the number of treated patients, those subsequently hospitalized and the type and number of adverse events. Any evidence of specific cardiovascular complications, in particular severe arrhythmias and/or possible related symptoms, was also requested. Sixty-five doctors completed the survey. 1558-2027 ß 2020 Italian Federation of Cardiology - I.F.C. All rights reserved. Results Fifty-eight GPs treated 350 patients with HCL at the first flu symptoms; in 76 of those azithromycin was also associated. Of the 274 patients treated with HCL only, 16 patients required subsequent hospitalization (5.8%). Minor complications (mainly gastrointestinal, diarrhoea) were found in eight patients (2.9%), none of whom had to interrupt treatment. No major cardiac complications were found. Of the 76 patients treated with the association, 4 patients were hospitalized (5.2%). Minor complications occurred in only two patients (2.6%) (Fig. 1). There were no reports of any major arrhythmias, syncope or sudden death. Comments The current small observational study of real flu affected patients in this area of high epidemic coronavirus outbreak, despite the study limitations, has shown that early, short duration HCL administration alone or/and azithromycin at home was safe and accompanied..