Coronavirus Disease 2019 Severity and Risk of Subsequent Cardiovascular Events.
PASC
SARS-CoV-2
long COVID
post-COVID syndrome
postacute COVID-19 syndrome
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
08 02 2023
08 02 2023
Historique:
received:
19
05
2022
pubmed:
20
8
2022
medline:
11
2
2023
entrez:
19
8
2022
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 35984816
pii: 6671924
doi: 10.1093/cid/ciac661
pmc: PMC9907540
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e42-e50Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
Déclaration de conflit d'intérêts
Potential conflicts of interest. All authors are employees and shareholders of Pfizer Inc. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Références
JAMA. 2015 Jan 20;313(3):264-74
pubmed: 25602997
MMWR Morb Mortal Wkly Rep. 2022 Apr 29;71(17):606-608
pubmed: 35482574
Gac Sanit. 2008 Mar-Apr;22(2):144-50
pubmed: 18420014
Front Cardiovasc Med. 2021 Oct 28;8:744482
pubmed: 34778405
Stroke. 2011 Jul;42(7):1851-6
pubmed: 21546476
MMWR Morb Mortal Wkly Rep. 2022 Apr 08;71(14):517-523
pubmed: 35389977
PLoS One. 2021 Aug 4;16(8):e0254347
pubmed: 34347785
MMWR Morb Mortal Wkly Rep. 2022 Jan 14;71(2):59-65
pubmed: 35025851
Eur J Immunol. 2021 Apr;51(4):893-902
pubmed: 33368288
BMJ Open. 2021 Dec 10;11(12):e056284
pubmed: 34893488
JAMA Netw Open. 2021 Sep 1;4(9):e2127403
pubmed: 34586367
Lancet. 2021 Aug 14;398(10300):599-607
pubmed: 34332652
Circ Res. 2021 Apr 16;128(8):1214-1236
pubmed: 33856918
Circulation. 2014 Apr 1;129(13):1387-96
pubmed: 24523433
Transl Res. 2022 Mar;241:25-40
pubmed: 34780967
N Engl J Med. 2020 Jul 23;383(4):334-346
pubmed: 32598831
J Am Soc Echocardiogr. 2021 Dec;34(12):1273-1284.e9
pubmed: 34508837
Am J Respir Crit Care Med. 2014 May 1;189(9):1065-74
pubmed: 24456535
Nat Commun. 2022 Apr 12;13(1):1957
pubmed: 35413949
Curr Opin Infect Dis. 2014 Jun;27(3):295-301
pubmed: 24685550
Pharmacoepidemiol Drug Saf. 2021 Jul;30(7):827-837
pubmed: 33797815
Clin Infect Dis. 2007 Jul 15;45(2):158-65
pubmed: 17578773
N Engl J Med. 2004 Dec 16;351(25):2611-8
pubmed: 15602021
Lancet. 2021 Jan 16;397(10270):220-232
pubmed: 33428867
Nature. 2021 Jun;594(7862):259-264
pubmed: 33887749
JAMA Netw Open. 2021 Oct 1;4(10):e2128568
pubmed: 34643720
Eur Heart J. 2022 Mar 14;43(11):1157-1172
pubmed: 35176758
Medicine (Baltimore). 2009 May;88(3):154-159
pubmed: 19440118
Cell. 2022 Mar 3;185(5):881-895.e20
pubmed: 35216672
Sao Paulo Med J. 2021 Aug 30;139(6):543-544
pubmed: 34468629
Scand J Infect Dis. 2009;41(6-7):511-4
pubmed: 19396667
Clin Infect Dis. 2021 Dec 6;73(11):e4124-e4130
pubmed: 33410884
MMWR Morb Mortal Wkly Rep. 2021 Sep 17;70(37):1274-1277
pubmed: 34529639
JAMA Neurol. 2020 Aug 1;77(8):1018-1027
pubmed: 32469387
Am J Respir Crit Care Med. 2016 Jul 15;194(2):209-17
pubmed: 26808711
Clin Infect Dis. 2008 Jul 15;47(2):182-7
pubmed: 18533841
Cardiol J. 2022;29(1):178-179
pubmed: 34811716
Nat Med. 2022 Mar;28(3):583-590
pubmed: 35132265
Front Cardiovasc Med. 2022 Jan 05;8:760651
pubmed: 35071343
J Med Econ. 2022 Jan-Dec;25(1):334-346
pubmed: 35293285
N Engl J Med. 2022 Apr 7;386(14):1314-1326
pubmed: 35196424
Nat Med. 2021 Apr;27(4):601-615
pubmed: 33753937
JCI Insight. 2021 Jul 8;6(13):
pubmed: 34061779
Heart Rhythm. 2016 Jun;13(6):1189-94
pubmed: 26850784
Nat Commun. 2021 Sep 14;12(1):5417
pubmed: 34521836
Lancet. 1998 May 16;351(9114):1467-71
pubmed: 9605802
Am J Med. 2021 Dec;134(12):1451-1456
pubmed: 34390682
Semin Thromb Hemost. 2022 Feb;48(1):112-114
pubmed: 33860515
Expert Rev Cardiovasc Ther. 2021 Oct;19(10):881-889
pubmed: 34702128