HİDROKSİKLOROKİN TEDAVİSİ ALACAK COVID-19 HASTALARINDA ELEKTROKARDİYOGRAFİ TAKİBİNİ ERKEN SONLANDIRAN TELETIP TEMELLİ ALGORİTMA

Amaç: Koronavirüs 19 (COVID-19)’a bağlı pnömoni tedavisinde QT’yi uzatıp ölümcül aritmik olay geliştirme potansiyeli olan ilaçlar telemetrik ya da elektrokardiyografik (EKG) düzeltilmiş QT (QTc) takibi ile kullanılmıştır. Yakın zamanda geliştirilen birçok algoritma sıkı QTc takibi önerirken biz QTc takibini erken sonlandıran teletıp temelli QTc takip algoritması geliştirdik. Bu çalışmada algoritmanın uygulanabilirliği ve güvenilirliğini araştırdık. Gereç ve Yöntem: COVID-19’a bağlı pnömoni tedavisinde en az 2 doz hidroksiklorin almış ve dijital QTc takip platformunda EKG kayıtları paylaşılan hastalar çalışmaya dâhil edildi. Bulgular: Hastalar, birbirini izleyen iki EKG bulgusuna göre erken takipten çıkarılan (n = 92), takibe devam edilen (n = 12) ve EKG takibi olmayan olağan bakım hastaları (n= 68) gruplarına ayrıldı. Hastalara standart günlük EKG takibi yapılsaydı 975 EKG çekilecekti. Erken dışlama algoritmasıyla, standart uygulamasının aksine 237 EKG izlemi gerçekleştirilmiştir. Bu sayede 738 (% 75,7) daha az EKG çekimi ile sağlık çalışanlarının COVID-19 hasta ile maruziyeti azaltılmıştır. Hasta popülasyonunda hiçbir olguda sürekli ventriküler aritmi veya ani kardiyak ölüm gözlenmemiştir. Sonuç: Hidroksiklorokin tedavisi gören COVID-19 hastalarında teletıp tabanlı erken dışlama algoritmasını uygulamak güvenlidir. Bu algoritma, riski arttırmadan bu hastalarda fazla EKG ihtiyacını ortadan kaldırmıştır. Benzer algoritmalar EKG takibini erken sonlandırarak EKG çekimini ve sağlık çalışanlarının COVID-19 hastaları ile maruziyetini önemli oranda azaltabilir.

Telemedicine-based early rule out electrocardiography algorithm:Hydroxychloroquine in COVID-19 patients

Objective: Drugs with the potential to prolong QT are used in the treatment of coronavirus 19 (COVID-19) pneumonia. We have developed a telemedicinebased corrected QT (QTc) follow-up algorithm that allows early rule out for follow up. In this study, we investigated the availability and safety of the algorithm. Materials and Methods: Consecutive patients; administered hydroxychloroquine (HCQ) for COVID-19 pneumonia were enrolled into digital ECG recording program which includes QTc follow-up algorithm. Results: Patients were classified into three groups as follows: Those excluded promptly from the QTc follow-up based on two consecutive ECG findings (early rule out, n=92) and those for whom the follow-up was continued (n=12) and the usual care group (n=68). Of note, 237 ECG tracings were performed in our algorithm population contrary to standard practice of daily-recommended ECG monitoring which could have yielded 975 ECG tracings along with accompanied risks of exposure. This way; we ended in 738 (75.7%) fewer ECG tracings. Sustained ventricular arrhythmia or sudden cardiac death was not observed in the entire patient population. Conclusion: It is safe to rely on telemedicine-based early rule out algorithm in COVID-19 patients, receiving hydroxychloroquine treatment. This algorithm abolished the need for further ECG in majority of patients without increased risk during follow up. These algorithms can significantly reduce the healthcare worker exposures by eliminating the need for ECG follow-up promptly.

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