Cardiovascular Complications of COVID-19 Increased Throughout the Pandemic

Throughout the duration of the pandemic, incidence of cardiovascular complications secondary to COVID-19 infection has increased.

The incidence of diagnosed cardiovascular complications of COVID-19 increased from the beginning of the pandemic through the end of 2021, although the profile of hospitalized patients with COVID-19 changed toward younger individuals with a lower prevalence of previously established cardiovascular disease (CVD), according to a study in Circulation: Cardiovascular Quality and Outcomes.

Researchers assessed the longitudinal prevalence of CVD risk factors and the incidence of diagnosed CVD complications in hospitalized patients with COVID-19 with use of the American Heart Association’s COVID-19 Cardiovascular Disease Registry, which is available to all hospitals in the United States (US).

Participants were adult patients (aged ≥18 years) who were hospitalized with active COVID-19 as the primary diagnosis.

The observational study used a repeated cross-sectional design to analyze separate groups of patient admissions during distinct time periods. The period from March 2020 to December 2021 was divided into 8 time epochs to identify trends over time. March 2020 was regarded as a separate time epoch, and the remaining study period was grouped into 3-month epochs.

These data suggest that patients with COVID-19 infection severe enough to require admission may remain at substantial risk of cardiovascular morbidity and all-cause mortality.

The primary CVD composite outcome included myocardial infarction (MI), stroke, new heart failure, cardiogenic shock, and in-hospital death owing to cardiovascular causes.

The analysis included 46,007 patient admissions from 134 hospitals. The patients had a mean age of 62±18 years and 53% were men. White patients comprised 51% of the cohort, Black patients 22%, and Hispanic patients 19%. CVD risk factors were observed in 84% of patients.

Individuals who were admitted during the earlier time epochs tended to be older than those who were admitted from March 2021 onward and were less likely to have pre-existing CVD (Ptrend<.0001). The overall proportion of obese patients was 49%, and a modest trend was observed toward increased obesity rates later in the study period.

The crude incidence of the primary composite outcome was 7.5% during the entire study period. The incidence of the primary outcome increased from 7.0% in March 2020 to 9.8% from October to December 2021 (Ptrend <.0001). The rate of the primary cardiovascular outcome increased in later time epochs (adjusted P =.006), as well as in the secondary analysis limited to July 2020 to December 2021 (adjusted P =.006), after adjustment for baseline demographics, comorbidities, and illness severity at admission.

For the primary outcome components, MI and stroke occurred in 3.6% and 1.8% of the cohort during the entire study period, although the incidence of both diagnoses increased modestly with time. The overall incidence of venous thromboembolism increased over time, primarily accounted for by an increase in diagnosed pulmonary embolism (Ptrend <.0001).

All-cause, in-hospital mortality was 14.2% for the full study period. The mortality rate was highest in March 2020 (20.8%), with significantly decreased rates of crude and risk-adjusted hospital mortality occurring in subsequent time epochs (unadjusted Ptrend <.0001 and adjusted Ptrend <.0001).

When the analysis was limited to July 2020 to December 2021, no significant change in mortality was observed (unadjusted Ptrend =0.24, adjusted Ptrend =0.63). Overall, 9% of deaths were due to a cardiovascular cause, and respiratory causes accounted for 72% of deaths.

The investigators noted that the sample size and the number of centers contributing to the registry varied throughout the pandemic. In addition, COVID-19 surges affected different US regions at different times, and the approach used to categorize time epochs did not account for these potential regional differences.

“These data suggest that patients with COVID-19 infection severe enough to require admission may remain at substantial risk of cardiovascular morbidity and all-cause mortality,” wrote the researchers.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Hall EJ, Ayers CR, Kolkailah AA, et al. Longitudinal trends in cardiovascular risk factor profiles and complications among patients hospitalized for COVID-19 infection: results from the American Heart Association COVID-19 cardiovascular disease registry. Circ Cardiovasc Qual Outcomes. Published online April 5, 2023. doi: 10.1161/CIRCOUTCOMES.122.009652