Long COVID Patients at Increased Risk for Cardiovascular Conditions, Study Finds

As the number of long COVID cases grows, healthcare providers need to learn more about these patients.

Long COVID patients experience increased risk for several cardiovascular conditions in the year after coronavirus infection, a new research article found.

Long COVID, also known as post-COVID-19 condition (PCC), is defined as having new, returning, or ongoing health issues more than four weeks after an initial infection, according to the Centers for Disease Control and Prevention. Symptoms that lead to a diagnosis of long COVID include fatigue, cough, loss of taste or smell, shortness of breath, neurocognitive difficulties, and depression.

The new research article, which was published by JAMA Health Forum, features data collected from 13,435 long COVID adult patients and a control group of 26,870 adults without COVID-19. The data was drawn from national commercial insurance claims along with laboratory results and mortality data from the Social Security Administration's Death Master File and Datavant Flatiron data.

The research article has several key findings:

• The long COVID patients experienced increased healthcare utilization for cardiac arrhythmias (relative risk 2.35).
   
• The long COVID patients experienced increased healthcare utilization for pulmonary embolism (relative risk 3.64).
   
• The long COVID patients experienced increased healthcare utilization for ischemic stroke (relative risk 2.17).
   
• The long COVID patients experienced increased healthcare utilization for coronary artery disease (relative risk 1.78).
   
• The long COVID patients experienced increased healthcare utilization for heart failure (relative risk 1.97).
   
• The long COVID patients experienced increased healthcare utilization for chronic obstructive pulmonary disease (relative risk 1.94).
   
• The long COVID patients experienced increased healthcare utilization for asthma (relative risk 1.95).
   
• Risks for these conditions were higher for long COVID patients who were hospitalized during the acute phase of coronavirus infection compared to long COVID patients who were not hospitalized.
   
• The long COVID patients also experienced increased mortality, with 2.8% of long COVID patients dying compared to 1.2% of individuals in the control group. This translated to an excess death rate of 16.4 per 1,000 individuals.

The long COVID patients in the study were at significantly higher risk for adverse outcomes in the year after initial infection, the research article's co-authors wrote. "This case-control study leveraged a large commercial insurance database and found increased rates of adverse outcomes over a 1-year period for a PCC cohort surviving the acute phase of illness. The results indicate a need for continued monitoring for at-risk individuals, particularly in the area of cardiovascular and pulmonary management."

Interpreting the data

Even for adults who are not hospitalized, long COVID patients are at risk for serious conditions and mortality, the study's co-authors wrote.

"Based on published literature, the most common symptoms experienced by individuals with PCC include fatigue, headache, and attention disorder. While these symptoms are concerning, results from this study also indicated a statistically significant increased risk for a range of cardiovascular conditions as well as mortality. While these risks were heightened for individuals who experienced a more severe acute episode of COVID-19 (ie, requiring hospitalization), it is essential to note that most individuals (72.5%) in the cohort did not experience hospitalization during the acute phase."

As the number of long COVID cases grows, healthcare providers need to learn more about these patients, the study's co-authors wrote. "Gaining additional insight into the risks and trajectory of the disease is essential for clinicians caring for these individuals, especially a need for primary prevention for individuals at higher risk. At a health-systems level, it is also necessary to develop resources and guidance for individuals at risk for serious complications."

The study has significant implications, they wrote. "From a health policy perspective, these results also indicate a meaningful effect on future healthcare utilization, and even potential implications for labor force participation. Gaining knowledge on the scope and trajectory of PCC is relevant for policy makers, given the recent guidance by the US Department of Health and Human Services that classifies 'long COVID' as a disability if it substantially limits major life activities."

Related: Treat Coronavirus 'Long Haulers' With Multidisciplinary and Comprehensive Approach