Large increases in the risk of cardiovascular events following COVID-19 infection that required hospitalization

Reference

Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med 2022;28:583-590.

Synopsis

This was a retrospective cohort study that identified 5,637,647 veterans who were enrolled in the US Veterans Health Administration (VHA) system in 2019 who did not have a documented positive test result for COVID-19 and 153,760 who were alive 30 days after a positive result for COVID-19. The distribution of entry dates was adjusted to maintain the comparability of groups. The authors also identified an historical cohort of VHA patients cared for during the 2 years prior to the pandemic. The mean age of the cohorts was 61 to 63 years, approximately 20% were Black, and 90% were men. The authors balanced COVID-19 positive and COVID -19 negative groups using propensity scores and did an adjusted analysis. They used a positive outcome control (fatigue) to confirm that they found an association that they expected, and several negative outcome controls (eg, diagnosis of melanoma in situ, hypertrichosis, and lymphoma) to confirm that they did not find an unexpected association. Results for the historical and contemporary controls were similar, and results for the positive and negative outcome controls were as expected. The likelihood of a patient with COVID-19 infection experiencing every cardiovascular condition was significantly increased, with hazard ratios for most between 1.5 and 2.5. The risk was increased much more for hospitalized patients, especially those who had been cared for in the intensive care unit (ICU). For example, there would be approximately 5 additional diagnoses of heart failure in 1000 nonhospitalized patients, 45 additional diagnoses of heart failure in 1000 hospitalized patients, and 78 additional diagnoses in 1000 ICU patients. For cerebrovascular disease, the corresponding excess burdens per 1000 are 3, 20, and 31 events for nonhospitalized, hospitalized, and ICU patients, respectively. Hazard ratios were somewhat higher among persons without pre-existing cardiovascular disease, and were consistent by age, race, and sex. The excess burdens of the composite of all-cause mortality, myocardial infarction, and stroke were 13, 51, and 138 per 1000 persons for nonhospitalized, hospitalized, and ICU patients, respectively, and for any cardiovascular event were 26, 161, and 312 for the 3 care settings in that same order.