Azithromycin ups risk for acute HF, death in patients with prior CVD, COVID-19
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Key takeaways:
- Azithromycin may increase risk for acute HF and subsequent death among hospitalized patients with COVID-19 and prior CVD.
- Those with no prior CVD had no increased risk for acute HF tied to antimicrobial therapy.
Use of azithromycin was associated with acute heart failure among patients with a history of CVD hospitalized with SARS-CoV-2 infection compared with standard care, researchers in Europe reported.
Among hospitalized patients with SARS-CoV-2 infection, those with acute HF experienced a more than twofold increased risk for death compared with patients without acute HF, according to a study published in the Journal of the American Heart Association.
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“Based on the current concepts of viral pathogenesis and potential pneumonia coinfection, empiric azithromycin therapy for pulmonary SARS-CoV-2 pneumonia is rational. However, the same cannot be said for cardiac manifestations of SARS-CoV-2,” Maria Bergami, MD, PhD, of the department of medical and surgical sciences at the University of Bologna, Italy, and colleagues wrote. “We performed a comprehensive analysis of the relationship between azithromycin use and outcomes in CVD through a large multicenter cohort study of adults hospitalized for COVID-19 across five European countries. The aim was to establish whether azithromycin increases cardiac complications and whether its effect on cardiac complications and mortality varies according to the presence of previous CVD.”
Using the International Survey of Acute Coronavirus Syndromes (ISACS)-COVID-19 registry, Bergami and colleagues identified 793 patients exposed to azithromycin within 24 hours from hospital admission with SARS-CoV-2 infection and 2,141 more infected patients who received standard care. Overall, 36.4% of the cohort had preexisting CVD.
The main outcomes of interest were 30-day mortality and acute HF, which occurred in 21% and 8.6% of the cohort, respectively.
The researchers observed that azithromycin was significantly associated with risk for acute HF among patients with preexisting CVD compared with standard care (RR = 1.48; 95% CI, 1.06-2.06) and was not significantly associated with 30-day mortality in that group (RR = 0.94; 95% CI, 0.69-1.28).
However, in patients with no prior CVD, azithromycin was not associated with any significant increase in risk for acute HF compared with standard care (RR = 1.23; 95% CI, 0.75-2.04) and was significantly associated reduced risk for 30-day mortality (RR = 0.57; 95% CI, 0.42-0.79).
The relative risk for 30-day mortality was lower among patients without prior CVD compared with those with preexisting CVD (P for interaction = .01), and the researchers reported a significant association between acute HF and death (OR = 2.28; 95% CI, 1.34-3.9).
These findings were consistent among patients treated with corticosteroids or antiviral agents, according to the study.
“Although azithromycin is one of the most commonly prescribed antibiotics during the COVID-19 pandemic, its use has been associated with an increased risk of cardiovascular complications and death in some prior studies on COVID-19-free populations,” the researchers wrote. “In this COVID-19 cohort study, after adjustment with inverse probability of treatment weighting, azithromycin therapy was consistently associated with an increased risk of acute heart failure and death in patients with preexisting cardiovascular disease, but not in those free of previous cardiovascular disease.”
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