Incidence of bradycardia with the use of remdesivir for coronavirus disease of 2019 and risk factor analysis.

Background: Remdesivir is commonly used for inpatient treatment of coronavirus disease of 2019 (COVID-19) and may be associated with bradycardia. The objective is to investigate the incidence of bradycardia in patients with COVID-19 receiving remdesivir and evaluate potential risk factors associated with bradycardia.

Methods: This single-center, retrospective, cohort study evaluated the incidence of bradycardia during and up to 48 h after remdesivir administration in adults admitted to the medical center for treatment of COVID-19. Secondary endpoints included time to bradycardia after remdesivir administration, incidence of severe bradycardia, incidence of early remdesivir discontinuation due to bradycardia, interventions to treat bradycardia, and inpatient mortality. Univariate analyses were performed to determine factors associated with remdesivir-related bradycardia. Risk factors significant at the 0.20 level in the univariate analysis were entered into a stepwise backward regression analysis to evaluate potential risk factors.

Results: Bradycardia occurred in 61 (49.2%) of patients with a median nadir of 50 bpm. Median baseline heart rate (HR) was lower in patients who developed bradycardia (79 [67-89] vs. 91 [80-100] < 0.001). Patients who developed bradycardia had a trend for more nonblack race, higher severity of illness, concurrent acute respiratory distress syndrome diagnosis, history of liver disease, and less hypomagnesemia. Only baseline HR as measured before remdesivir initiation was independently associated with bradycardia by multivariate analysis. Patients who developed bradycardia had a higher inpatient mortality (26.2% vs. 11.1%, = 0.03).

Conclusion: Remdesivir-associated bradycardia is common. Baseline HR was identified as an independent risk factor for bradycardia in hospitalized patients being treated with remdesivir for COVID-19.