(1371) Remdesivir-Associated Bradycardia: A Retrospective Cohort Study in an Urban Tertiary-Care Center

Introduction: Remdesivir’s potential association with bradycardia has been reported in the literature. Our study investigated the relationship between remdesivir and bradycardia events in hospitalized COVID-19 patients in an urban tertiary care center.

Methods: We completed a retrospective cohort study of a simple random sample among those with COVID-19 code as a diagnosis. Sample data was recorded between November 1, 2020, and December 31, 2022. Our study population was a total of 522 patients (n=236 in the control group, n=286 in the treatment group). Patients were classified into subgroups based on heart rate (normal >60, mild 60-51, moderate 50-41, or severe < 40 beats per minute). We performed Spearman’s correlation analysis to determine if there is any association between treatment with remdesivir and bradycardia events.

Results: The mean age of our population was 55.03 years old. Of the study population, 47.7% were male, and 52.3% were female. The mean length of stay in the hospital was 10.13 days. Among the control group, 30 patients had bradycardia events (12.71%), whereas 60 patients had bradycardia events in the treatment group (20.98%). These findings, however, were not statistically significant p=0.078. Among the control group, 7 patients had a cardiac arrest while in the hospital (3.0%) versus 2 patients in the treatment group (0.7%) (p=0.048). Among the control group, 46 patients had to be transferred to a higher level of care (19.49%), whereas 57 patients were transferred in the treatment group (19.93%) (p=0.052). There was a weak correlation between remdesivir treatment and length of stay (Spearman’s rho 0.288, p < 0.000) and a negligible correlation between remdesivir treatment and bradycardia events (Spearman’s rho 0.110, p=0.012).

Conclusions: We found no significant association between treatment with remdesivir and bradycardia events, as the correlation was negligible. However, it is important to consider that nearly 21% of the remdesivir treatment patients had some level of bradycardia versus 13% in the control group. Of note, the COVID-19 virus alone has been associated with bradycardia events due to the systemic inflammatory effect and its potential to affect cardiac myocytes. Therefore, clinicians must consider these factors and monitor patients with increased vigilance.