Azithromycin use may elevate risk of AHF and mortality among COVID-19 Patients with pre existing CVD

In the ongoing battle against COVID-19, empirical antimicrobial therapy with azithromycin has emerged as a frequently used option for patients admitted to hospitals with COVID-19. Researchers have found in a new study that azithromycin use in patients with COVID‐19 and prior history of CVD is significantly associated with an increased risk of AHF and all‐cause 30‐day mortality.

The findings were published Journal of the American Heart Association.

The ISACS-COVID-19 registry study, which involved data from 793 patients exposed to azithromycin within 24 hours of hospital admission and 2141 patients who received standard care only, sought to investigate the impact of azithromycin therapy on COVID-19 patients, especially in relation to cardiovascular disease (CVD). The primary goal was to examine the 30-day mortality and acute heart failure (AHF) rates in these patients.

The results of the study were striking. Out of the 2934 patients involved, 1066 (36.4%) had preexisting CVD. Among the total number of patients, 617 (21.0%) sadly lost their lives, and 253 (8.6%) experienced acute heart failure.

Of significant concern was the finding that azithromycin therapy was consistently linked to an increased risk of acute heart failure in patients who had preexisting cardiovascular disease. The risk ratio (RR) for AHF in this group was calculated to be 1.48 [95% CI, 1.06–2.06]. However, the use of azithromycin in comparison to standard care did not show a significant association with patient mortality (RR, 0.94 [95% CI, 0.69–1.28]).

Remarkably, the study revealed a stark contrast between patients with prior CVD and those without it. Patients without preexisting CVD who received azithromycin demonstrated a reduced risk of death (RR, 0.57 [95% CI, 0.42–0.79]), and there was no significant increase in the risk of acute heart failure (RR, 1.23 [95% CI, 0.75–2.04]).

The relative risks of death between the two subgroups were found to be significantly different from each other (Pinteraction=0.01). Additionally, the study identified a statistically significant association between acute heart failure and death (odds ratio, 2.28 [95% CI, 1.34–3.90]).

Source:

Bergami, M., Manfrini, O., Nava, S., Caramori, G., Yoon, J., Badimon, L., Cenko, E., David, A., Demiri, I., Dorobantu, M., Fabin, N., Mendieta, G., … Bugiardini, R. (2023). Relationship Between Azithromycin and Cardiovascular Outcomes in Unvaccinated Patients With COVID‐19 and Preexisting Cardiovascular Disease. In Journal of the American Heart Association (Vol. 12, Issue 14). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/jaha.122.028939