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Multicenter Study

Long COVID and cardiovascular disease: a prospective cohort study

Claire Alexandra Lawson et al. Open Heart. .

Abstract

Background: Pre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known.

Objectives: To determine whether the rate of patient-perceived recovery following hospitalisation with COVID-19 was affected by the presence of CVD or cardiovascular risk factors.

Methods: In a multicentre prospective cohort study, patients were recruited following discharge from the hospital with COVID-19 undertaking two comprehensive assessments at 5 months and 12 months. Patients were stratified by the presence of either CVD or cardiovascular risk factors prior to hospitalisation with COVID-19 and compared with controls with neither. Full recovery was determined by the response to a patient-perceived evaluation of full recovery from COVID-19 in the context of physical, physiological and cognitive determinants of health.

Results: From a total population of 2545 patients (38.8% women), 472 (18.5%) and 1355 (53.2%) had CVD or cardiovascular risk factors, respectively. Compared with controls (n=718), patients with CVD and cardiovascular risk factors were older and more likely to have had severe COVID-19. Full recovery was significantly lower at 12 months in patients with CVD (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.89) and cardiovascular risk factors (aOR 0.66, 95% CI 0.50 to 0.86).

Conclusion: Patients with CVD or cardiovascular risk factors had a delayed recovery at 12 months following hospitalisation with COVID-19. Targeted interventions to reduce the impact of COVID-19 in patients with cardiovascular disease remain an unmet need.

Trail registration number: ISRCTN10980107.

Keywords: CARDIAC REHABILITATION; COVID-19; RISK FACTORS.

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Conflict of interest statement

Competing interests: KK is chair of the ethnicity subgroup of the UK Scientific Advisory Group for Emergencies (SAGE) and is a member of SAGE. KK (Chair) and RE are members of the Long COVID Epidemiological Research Group that reports to the CMO. CB is an author of the COVID-19 rapid guideline: managing the long-term effects of COVID-19 NICE guideline (NG188) https://www.nice.org.uk/guidance/ng188/history. CB is a member of the NHS National Services Scotland Long COVID group and his employer, the University of Glasgow, holds a research agreement with AstraZeneca and Somalogic for research in COVID-19. AJM is an employee of AstraZeneca.

Figures

Figure 1
Figure 1
Flow diagram. CVD, cardiovascular disease.
Figure 2
Figure 2
Recovery following COVID-19 stratified by disease/risk group. Probability of patient-perceived full recovery stratified by patients with established cardiovascular disease (red), patients at high risk of developing cardiovascular disease (dotted red), patients without either established cardiovascular disease or cardiovascular risk factors (blue).
Figure 3
Figure 3
Patient-reported outcome measures at 5 and 12 months stratified by disease/risk group. Patient-related outcome measures of quality of life (EQ-5D-5L) prior to COVID-19 infection and at 5 and 12 months stratified by disease group (A). Physiological assessment (ISWT) of maximal predicted walking distance adjusted for age at 5 and 12 months (B). Patients with established cardiovascular disease (red), patients at high risk of developing cardiovascular disease (dotted red), patients without either established cardiovascular disease or cardiovascular risk factors (blue). EQ-5D-5L, EuroQol 5D Questionnaire; ISWT, incremental shuttle walk test.
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