Azithromycin ups risk for acute HF, death in patients with prior CVD, COVID-19

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A new study conducted in Europe has found that the use of azithromycin, an antibiotic commonly prescribed during the COVID-19 pandemic, may increase the risk of acute heart failure (HF) and subsequent death among patients with prior cardiovascular disease (CVD). However, patients without prior CVD did not have an increased risk of acute HF associated with azithromycin therapy.

The study, published in the Journal of the American Heart Association, aimed to examine 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 researchers used the International Survey of Acute Coronavirus Syndromes (ISACS)-COVID-19 registry to identify 793 patients who were exposed to azithromycin within 24 hours of hospital admission with SARS-CoV-2 infection, as well as 2,141 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 study found that azithromycin was significantly associated with an increased risk of acute HF among patients with preexisting CVD, compared to standard care. However, it was not significantly associated with 30-day mortality in that group. On the other hand, in patients without prior CVD, azithromycin was not associated with any significant increase in the risk of acute HF compared to standard care, and it was even associated with a reduced risk of 30-day mortality.

The study also revealed that the relative risk for 30-day mortality was lower among patients without prior CVD compared to those with preexisting CVD. Furthermore, the researchers reported a significant association between acute HF and death. These findings were consistent among patients treated with corticosteroids or antiviral agents.

The authors of the study noted that while azithromycin is commonly prescribed during the COVID-19 pandemic, prior studies have associated its use with an increased risk of cardiovascular complications and death in COVID-19-free populations. This study provides further evidence of the potential risks associated with azithromycin therapy, specifically in patients with preexisting CVD.

In conclusion, the use of azithromycin in hospitalized patients with COVID-19 and prior CVD may increase the risk of acute HF and subsequent death. It is important for healthcare providers to carefully consider the risks and benefits of using azithromycin in these patients, particularly in those with underlying cardiovascular conditions. Further research is needed to better understand the mechanisms behind these associations and to inform clinical decision-making in the treatment of COVID-19.

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