Cardiovascular Disease Diagnoses Remain Elevated 3 Months After COVID-19 Infection

“Compared to the pre-COVID period, the odds ratio for CVD encounters was nearly doubled in each post-COVID period from 31 to 90 days post onset,” Brian Agan, MD, deputy science director and HIV research director of the Infectious Disease Clinical Research Program at USU/HJF and presenting author, told Contagion®.

Among the most troubling outcomes of the COVID-19 pandemic has been the thousands of reports of patients living with post-acute sequelae of SARS-CoV-2 infection or “long COVID” weeks—even months—after testing positive for the virus.

These patients continue to experience a smattering of persistent symptoms, from fatigue, cognitive dysfunction, and loss of smell and taste to joint pain, shortness of breath, and even cardiovascular disease, as clinicians strive to learn more about the long-term health effects of COVID-19 illness.

A team of investigators with the Uniformed Services University of the Health Sciences/Henry M Jackson Foundation for the Advancement of Military Medicine (USU/HJF) sought to better understand these clinical outcomes and undertook a survey and longitudinal electronic medical record (EMR) review of a population within the Military Health Systems (MHS), including active duty and beneficiaries.

“Especially for active duty, who must be ready and able to serve critical responsibilities that may be physically demanding, the threat of long-term sequelae from a highly transmissible and prevalent respiratory pathogen is of significant concern,” Brian Agan, MD, deputy science director and HIV research director of the Infectious Disease Clinical Research Program at USU/HJF and presenting author, told Contagion®.

In research presented virtually at IDWeek 2021, investigators found that cardiovascular disease (CVD) diagnoses, in particular, remained elevated through 3 months COVID-19 of illness onset.

“Compared to the pre-COVID period, the odds ratio for CVD encounters (ICD-10) was nearly doubled in each post-COVID period from 31 to 90 days post onset,” Agan said. “Further analyses are ongoing to evaluate the case characteristics, risk factors, and predictors for these outcomes.”

From March to December 2020, Agan and investigators analyzed MHS beneficiaries who were enrolled in the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) cohort, which totaled 1015 participants who were SARS-CoV-2-positive, symptomatic, and had 3-month follow-up data available in the EMR. Investigators conducted surveys in late 2020 to ascertain COVID-19 illness symptom severity and duration. The EMR provided details on health care encounter history before and after COVID-19 illness onset.

Using the available data and generalized linear models, while also controlling for age, sex, and race, investigators calculated odds of organ-system clinical diagnoses within the 3 months pre- and post-symptom onset.

Of the 1015 participants included in the analysis, investigators collected survey data more than 28 days post-symptom onset from 625 individuals. A total of 17% and 6% of them reported persistent symptoms 28-84 days and 85+ days, respectively, and 9.6% reported that they had not resumed normal activities by 1 month.

Beyond 28 days, dyspnea, loss of smell and/or taste, fatigue, and exercise intolerance were the most frequently reported symptoms. The first month post-symptom onset period, when compared with the period 61 to 90 days prior to symptom onset, was associated with increases of pulmonary diagnoses (adjusted odds ratio [aOR] = 57, 95% CI 28-112), renal (aOR = 29, 95% CI 10-84), cardiovascular (aOR = 7, 95% CI 5-11), and neurological diagnoses (aOR = 3, 95% CI 2-4). Investigators pointed out that cardiovascular disease diagnoses remained elevated through 3 months (aOR = 2, 95% CI 1-3).

“The persistent symptoms and increased post-COVID diagnoses may be highly relevant to job duties and everyday function given the involved pulmonary, cardiac, and neurocognitive domains,” Agan concluded. “These findings emphasize the long-term morbidity of COVID-19, even in a relatively young, healthy population, and reinforce the importance of mitigating SARS-CoV-2 infections, including through vaccination. We need additional studies to better understand the pathogenesis of long COVID and investigation of measures to identify risk for and preventive measures against long COVID among those infected with SARS-CoV-2.”

The study, “Long-term clinical outcomes following SARS-CoV-2 infection include persistent symptoms and cardiovascular disease beyond 3 months post-infection,” was presented virtually at IDWeek 2021, held September 29-October 3, 2021.