Impact of Remdesivir on Heart Rate and Bradycardia Incidence Among Hospitalized Adults With COVID-19.

Abstract

Background: Bradycardia is not currently described as an adverse effect in prescribing information for remdesivir but has been reported postapproval. Therefore, effects on heart rate (HR) and bradycardia incidence after remdesivir initiation may be underrecognized by clinicians.

Objective: To evaluate HR and bradycardia incidence after remdesivir initiation among patients with COVID-19.

Methods: This was a single-center, retrospective cohort study between May 1, 2020 and December 1, 2021. Hospitalized patients eligible for inclusion were ≥18 years and received > 1 dose of remdesivir. Patients were excluded if they were pregnant, incarcerated, or received new medications associated with bradycardia. The primary outcome was to evaluate differences in median HR among patients preremdesivir (up to 24 hours prior to remdesivir) and postremdesivir (first dose through the treatment duration). Secondary outcomes included bradycardia episodes postremdesivir, nadir HR postremdesivir, and interventions for bradycardia management. Variables to assess postremdesivir bradycardia were considered in multivariate logistic regression if they had a P < 0.1 on univariate analysis.

Results: Among 514 patients, 328 were included. Most were male (53.4%), had severe COVID-19 (59.8%), and median (interquartile range [IQR]) age was 62 (23.7) years. Median (IQR) remdesivir duration was 4.9 (1.5) days. Median (IQR) HR was significantly lower postremdesivir than preremdesivir (74 (15) vs 87 (19), P < 0.001). There were significantly more bradycardia episodes postremdesivir than before (48.8% [160/328] vs (2.4% [8/328]), P < 0.001). Among 48.8% (160/328) of patients with bradycardia postremdesivir, median (IQR) nadir HR was 53 (6.8). Remdesivir was discontinued early in 1 patient (0.6%). In multivariate logistic regression, remdesivir duration (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.04 to 1.54, P = 0.019) and median preremdesivir HR (OR = 0.96, 95% CI = 0.94 to 0.97, P < 0.001) were identified as significant predictors for bradycardia.

Conclusion and relevance: Remdesivir was associated with a significantly lower HR and higher incidence of bradycardia among hospitalized patients with COVID-19. These data may help improve recognition and management of these remdesivir-associated effects during COVID-19 treatment.