COVID-19 severity and risk of subsequent cardiovascular events.

ABSTRACT

BACKGROUND: Little is known about the relationship between 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 US adults. METHODS: Using a claims database, we performed a retrospective cohort study of adults diagnosed with COVID-19 between April 1, 2020 and May 31, 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: 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 [HR] 1.80 [95%CI 1.71-1.89]) or non-ICU hospitalization (HR 1.28 [1.24-1.33]). Risk of subsequent hospitalization for CVE was even higher (HR 3.47 [3.20-3.76] for ICU and HR 1.96 [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 SARS-CoV-2 infection from progressing to severe illness to reduce potential long-term cardiovascular complications.