COVID-19 patients face a heightened risk of poor cardiovascular (CV) outcomes, according to a new one-year analysis published in PLOS ONE.[1] However, such outcomes primary occurred in the first 30 days; days 31 to 365 were largely the same among patients with and without COVID-19.
“A high rate of thromboembolic complications has been consistently found in hospitalized patients with COVID-19,” wrote first author Luis Ortega-Paz, MD, a cardiologist with the University of Florida College of Medicine in Jacksonville, and colleagues. “In particular, critically ill patients are at higher risk of major adverse CV outcomes, including in-hospital mortality. These adverse CV outcomes include venous thromboembolism (VTE), arterial thrombotic events (ATE) such as myocardial infarction, stroke or systemic embolism, and other cardiac conditions such as myocarditis and arrhythmias. Although the higher rates of adverse CV outcomes during the acute phase are well described, there are limited data beyond the acute setting. Furthermore, the lack of a control group in these studies precludes them from determining the role of COVID-19 on CV outcomes.”
The study focused on data from nearly 4,500 patients. While 80.8% of patients had a confirmed COVID-19 diagnosis, the other 19.2% did not have COVID-19. All patients were treated in one of 17 facilities in Spain and Italy from February to December 2020. Patients in the COVID-19 group were more likely to be old, male and present with comorbidities than patients in the control group. On the other hand, patients in the COVID-19 group were less likely to be active smokers or present with a history of cancer. COVID-19 vaccination rates were similar between the two groups.
COVID-19 patients (1.4%) and control patients (0.8%) had similar CV death rates after one year. There were also no significant differences in the causes of CV death between the two groups. Non-CV deaths, however, were much more likely among the COVID-19 group than the control group (16.3% vs. 3.2%).
COVID-19 patients, however, did experience higher rates of all-cause death (17.8% vs. 4%), pulmonary embolism (2.6% vs. 0.4%), serious cardiac arrhythmias (2.5% vs. 0.6%), VTE (3.7% vs. 0.4%) deep vein thrombosis (DVT) (1.8% vs. 0%), ischemic stroke (0.7% vs. 0%) and ATE (2.6% vs. 0.9%) than control patients.
Ortega-Paz et al. noted that nearly all of these differences disappeared when they focused on the post-acute phase of care (days 31 to 365). The exception to this rule was DVT.
The group also highlighted nine predictors of adverse CV outcomes during the post-acute phase of care for COVID-19 patients: prior valvular heart disease, prior pulmonary hypertension, prior atrial fibrillation, prior heart failure, hypertension, smoking, dependent functional health status, an active or previous cancer; and admission to an ICU.
These predictors may one day prove helpful to clinicians, but more work is still needed until that can become a reality.
“Ultimately, computing these factors into risk prediction tools requires further research to determine if they can adequately identify patients at higher risk who need closer follow-up,” the authors wrote.
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.