Coronavirus Disease 2019 Severity and Risk of Subsequent Cardiovascular Events

Abstract

Background: Little is known about the relationship between coronavirus disease 2019 (COVID-19) severity and subsequent risk of experiencing a cardiovascular event (CVE) after COVID-19 recovery. We evaluated this relationship in a large cohort of United States adults.

Methods: Using a claims database, we performed a retrospective cohort study of adults diagnosed with COVID-19 between 1 April 2020 and 31 May 2021. We evaluated the association between COVID-19 severity and risk of CVE >30 days after COVID-19 diagnosis using inverse probability of treatment-weighted competing risks regression. Severity was based on level of care required for COVID-19 treatment: intensive care unit (ICU) admission, non-ICU hospitalization, or outpatient care only.

Results: A total of 1 357 518 COVID-19 patients were included (2% ICU, 3% non-ICU hospitalization, and 95% outpatient only). Compared to outpatients, there was an increased risk of any CVE for patients requiring ICU admission (adjusted hazard ratio [aHR], 1.80 [95% confidence interval {CI}, 1.71-1.89]) or non-ICU hospitalization (aHR, 1.28 [95% CI, 1.24-1.33]). Risk of subsequent hospitalization for CVE was even higher (aHRs, 3.47 [95% CI, 3.20-3.76] for ICU and 1.96 [95% CI, 1.85-2.09] for non-ICU hospitalized vs outpatient only).

Conclusions: COVID-19 patients hospitalized or requiring critical care had a significantly higher risk of experiencing and being hospitalized for post-COVID-19 CVE than patients with milder COVID-19 who were managed solely in the outpatient setting, even after adjusting for differences between these groups. These findings underscore the continued importance of preventing severe acute respiratory syndrome coronavirus 2 infection from progressing to severe illness to reduce potential long-term cardiovascular complications.

Keywords: PASC; SARS-CoV-2; long COVID; post-COVID syndrome; postacute COVID-19 syndrome.

Figure 1.

Study flowchart. Abbreviations: COVID-19, coronavirus disease 2019; ICD-10, International Classification of Diseases, Tenth Revision; RTIE, Real-Time Insights and Evidence.

Figure 2.

Weighted cumulative incidence of cardiovascular events (CVEs) by level of care required among patients with coronavirus disease 2019. A, Any postacute CVE. B, Postacute CVE requiring hospital admission. Abbreviation: ICU, intensive care unit.

Figure 3.

Forest plot of adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) from competing risks survival analysis evaluating the association between site of care and incident cardiovascular events (CVEs) among patients with coronavirus disease 2019. A, Any postacute CVE. B, Postacute CVE requiring hospital admission. See Supplementary Tables 7 and 8 for raw values as well as weighted and unweighted aHRs with 95% CIs.