COVID-19 infection and incident myocarditis: A multi-site population-based propensity score-matched analysis

ABSTRACT

Background: COVID-19-infection manifestations range from asymptomatic infection to multi-organ failure and death. Cardiovascular complications from COVID -19 include myocarditis, acute myocardial infarction, heart failure. Population-level data is lacking on the relationship between COVID-19 and cardiovascular complications. Objectives: To examine the incidence of myocarditis, acute myocardial infarction (AMI), heart failure (HF) after COVID-19 infection. Methods: We used a retrospective cohort study using deidentified data from 50 health systems across the United States. Cohort groups were created using patients ≥18, who were admitted to hospitals for respiratory illness with COVID in 2020 and respiratory illness without COVID-19 for the years 2020 and 2019. There were 107,699 patients with COVID;77,499 patients with respiratory illness in 2020, and 112,898 patients with respiratory illness in 2019. The COVID group was matched to each of the respiratory illness groups by propensity score. Patients with prior specific cardiovascular events were excluded for the correspondent outcome analysis. Our outcomes were myocarditis, AMI, HF. Results: In the COVID-19 group, 79 patients had new-onset myocarditis compared to 29 patients in the non-COVID-19 control (Pneumonia/flu) group (OR 2.73, CI 95%, 1.78-4.18). In the COVID- 19 group, 1512 patients developed HF compared to 2,659 patients in the non-COVID-19 group, (OR 0.49, CI 95%, 0.46-0.52). 1125 patients in COVID-19 group had AMI compared to 1243 patients in non-COVID-19 group (OR 0.87, CI 95 %, 0.80-0.94). Conclusion: COVID-19 was associated with a high risk of incident myocarditis but unexpectedly lower rates of HF diagnosis, suggesting possible under testing (e.g., 2-D ECHO) and underdiagnosis.