One year after COVID-19 infection, US adults with lingering symptoms were at elevated risk for cardiovascular conditions such as ischemic stroke and blood clots in the lungs, according to a nationwide study published today in JAMA Health Forum.
Scientists from Elevance Health, a large commercial health insurance provider in Indianapolis, analyzed claims data, lab results, and Social Security Administration death data to assess the cardiovascular outcomes of 13,435 US adults with long COVID and 26,870 matched uninfected controls. Long-COVID patients had tested positive from April 2020 to July 2021. Average participant age was 50.1 years, and 58.4% were women.
73% of patients had nonsevere infections
In the year after infection, 2.8% of the long-COVID patients died, compared with 1.2% of controls, implying an excess death rate of 16.4 per 1,000 people.
Long-COVID patients also used more healthcare services for the treatment of abnormal heart rhythms (29.4% vs 12.5%; relative risk [RR], 2.35), blood clots in the lungs (8.0% vs 2.2%; RR, 3.64), ischemic stroke (3.9% vs 1.8%; RR, 2.17), coronary artery disease (17.1% vs 9.6%; RR, 1.78), heart failure (11.8% vs 6.0%; RR, 1.97), chronic obstructive pulmonary disease (COPD; 32.0% vs 16.5%; RR, 1.94), and asthma (24.2% vs 12.4%; RR, 1.95).
Among long-COVID patients, 27.5% were hospitalized in the first month after infection. This patient subgroup had more chronic conditions before infection than the larger long-COVID group, including high blood pressure (54.1%), type 2 diabetes (30.7%), COPD (22.2%), asthma (15.6%), and severe obesity (14.7%).
Hospitalized long-COVID patients had higher healthcare use for abnormal heart rhythms (51.7% vs 17.4%; RR, 2.97), blood clots in the lungs (19.3% vs 3.1%; RR, 6.23), ischemic stroke (8.3% vs 2.7%; RR, 3.07), coronary artery disease (28.9% vs 14.5%; RR, 1.99), heart failure (25.6% vs 10.1%; RR, 2.53), COPD (43.1% vs 19.2%; RR, 2.24), and asthma (31.6% vs 14.7%; RR, 2.15).
The most common persistent COVID-19 symptoms were shortness of breath (41%), anxiety (31%), muscle aches/weakness (30%), depression (25%), and fatigue (21%).
"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," the researchers wrote. "Many of these conditions will have lasting effects on quality of life."
The authors said their study was the largest national evaluation of commercially insured long-COVID-19 patients with a year of follow-up.
Many of these conditions will have lasting effects on quality of life.
"Assessing ongoing needs of this population will be crucial, especially as it relates to the onset of new chronic conditions following the initial illness," they wrote. "These findings will improve understanding of care needed for individuals with PCC [post-COVID-19 condition], as well as inform health care systems directing resources toward surveillance, follow-up, and case management to this population."
The danger of repeat infections
In a related editorial, Mark Czeisler, PhD, of Harvard Medical School, and Said Ibrahim, MD, MPH, MBA, at Hofstra/Northwell, said public health messaging needs to emphasize the cumulative long-COVID and cardiovascular risks posed by repeat COVID-19 infections, even after mild cases.
"We believe US public health agencies should respond to this scientific evidence and reimplement strategies aimed at reducing SARS-CoV-2 infections, especially as immune-evasive Omicron offspring combined with minimal mitigation measures point to infections rapidly affecting large portions of the population in winter 2023 and beyond," they wrote.
Czeisler and Ibrahim called for an enhanced focus on long COVID and its enduring cardiovascular risks in terms of research, public health, and clinical care. "More broadly, rigorous programs are needed to minimize future infections, which have consequences beyond acute COVID-19 illness, and to advance scientific and medical understanding of the pathophysiology of PCC, as well as its prevention and management," they concluded.