Cardiac Post-acute Sequelae symptoms of SARS-CoV-2 in Community-Dwelling Adults: Cross-sectional Study (preprint)

Objective To examine risk factors for cardiac-related PASC in community-dwelling adults after acute coronavirus disease 2019 (COVID-19) infection. Methods We performed a cross-sectional analysis among adults who tested positive for COVID-19. Outcomes were self-reported cardiac-related PASC. We conducted stepwise multivariable logistic regression to assess association between the risk factors (existing cardiovascular disease, pre-existing conditions, days since positive test, COVID hospitalization, age, sex, education, income) and cardiac-related PASC. Results Among a sample of 442 adults, mean(±SD) age was 45.4 (16.2) years, 71% female, 13% Black; 46% reported pre-existing conditions; 23% had cardiovascular (CV) risk factors; and 4% had cardiovascular diseases (CVD). The prevalence of persistent cardiac-related symptoms and newly diagnosed cardiac conditions was 43% and 27%, respectively. The odds for cardiac-related PASC were 2.01 (95%CI: 1.27-3.17) higher in persons with underlying CV risk factors/CVD than in those without. The odds for cardiac-related PASC were higher among persons with underlying pre-existing conditions (adjusted odds ratio aOR: 2.00, 95% CI:1.28-3.10) and among those who were hospitalized (aOR: 3.03, 95%CI:1.58-5.83). Conclusions More than a third of persons with COVID-19 reported cardiac-related PASC symptoms. Risk factors for cardiac-related PASC symptoms include underlying CV risk factors/CVD, pre-existing conditions, increasing age, and COVID-19 hospitalization. COVID-19 may play an important role in worsening the prognosis of existing CV risk factors and increasing risk of complications. Key Messages What is already known on this topic Infection with SARS-CoV-2 virus may lead to persistent cardiac symptoms indicative of cardiac injury. COVID-19 may play an important role in worsening the prognosis of existing CVD and pre-existing conditions. What this study adds Little is known about characterization of cardiac-related Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) and recovery in community-dwelling adults. Hence, this study provides further evidence on the burden of possible cardiac-related PASC symptoms and diagnosed cardiac conditions. The findings also suggest that underlying CVD, pre-existing conditions, older age, and COVID-19 hospitalization, may be risk factors for persistent cardiac-related PASC symptoms. How this study might affect research, practice or policy These results underscore urgent needs for coordinated efforts directed at resource allocation and optimization of primary care for persons with cardiac PASC and for prevention of resulting CV events and complications

Subclinical Myocardial Injury, Coagulopathy, and Inflammation in COVID-19: A Meta-Analysis of 41,013 Hospitalized Patients (preprint)

Background: Infection with SARS-CoV-2 virus can lead to myocardial injury, with cardiac biomarker elevations. Objective: To quantify association between biomarkers of myocardial injury, coagulation, and severe COVID-19 and death in hospitalized patients. Methods: Studies were identified from electronic databases, published between December 2019 to August 2021. Effect estimates for association between markers of myocardial injury (Troponin), myocardial stretch (N-terminal-pro hormone BNP, NT-proBNP), and coagulopathy (D-Dimer) and death or severe/critical COVID-19 were pooled using random-effects models. Odds Ratios (OR), Hazard Ratios (HR), were pooled separately and reported by outcomes of critical/severe COVID-19 and death. A meta-analysis of proportions summarized pooled prevalence of co-morbidities. Results: We included 62 articles, with a total of 41,013 patients. The pooled proportion of patients with history of hypertension was 39% (95% CI: 34-44%); diabetes, 21% (95% CI: 18%-24%); coronary artery disease, 13% (95% CI: 10-16%); chronic obstructive pulmonary disease, 7% (95% CI: 5-8%), and history of cancer, 5% (95% CI: 4-7%). Elevated troponin was associated with higher pooled odds of critical/severe COVID-19 and death [Odds Ratio (OR: 1.76, 95% CI: 1.42-2.16)]; and also separately for death (OR: 1.72, 95% CI: 1.32-2.25), and critical/severe COVID-1919 (OR: 1.93, 95% CI: 1.45-2.40). Elevations in NT-proBNP were also associated with higher severe COVID-19 and death (OR: 3.00, 95% CI: 1.58-5.70). Conclusions : This meta-analysis synthesizes evidence showing that myocardial injury, and coagulopathy are complications of COVID-19. Patients who have recovered from COVID-19 may benefit from minimally invasive assessment for markers of myocardial injury, stretch and coagulopathy for early risk stratification.Funding: There was no funding for the study.Declaration of Interests: The authors report no relationships that could be construed as a conflict of interest.

Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study: Study Design (preprint)

The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) is a national prospective study of adults at risk for coronavirus disease 2019 (COVID-19) comprising 14 established United States (US) prospective cohort studies. For decades, C4R cohorts have collected extensive data on clinical and subclinical diseases and their risk factors, including behavior, cognition, biomarkers, and social determinants of health. C4R will link this pre-COVID phenotyping to information on SARS-CoV-2 infection and acute and post-acute COVID-related illness. C4R is largely population-based, has an age range of 18-108 years, and broadly reflects the racial, ethnic, socioeconomic, and geographic diversity of the US. C4R is ascertaining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 illness using standardized questionnaires, ascertainment of COVID-related hospitalizations and deaths, and a SARS-CoV-2 serosurvey via dried blood spots. Master protocols leverage existing robust retention rates for telephone and in-person examinations, and high-quality events surveillance. Extensive pre-pandemic data minimize referral, survival, and recall bias. Data are being harmonized with research-quality phenotyping unmatched by clinical and survey-based studies; these will be pooled and shared widely to expedite collaboration and scientific findings. This unique resource will allow evaluation of risk and resilience factors for COVID-19 severity and outcomes, including post-acute sequelae, and assessment of the social and behavioral impact of the pandemic on long-term trajectories of health and aging.