Risk of death elevated for 18 months after COVID-19: study

In the first three weeks after infection with COVID-19, patients are 81 times more likely to die than uninfected individuals, and the risk remains five times higher up to 18 months later, according to a new study published in Cardiovascular Research.

The study included almost 160,000 participants and found that COVID-19 is associated with higher risks of cardiovascular disease and death in the short and long term.

“COVID-19 patients were more likely to develop numerous cardiovascular conditions compared to uninfected participants, which may have contributed to their higher risks of death,” said study author Professor Ian CK Wong of the University of Hong Kong, China.

“The findings indicate that patients with COVID-19 should be monitored for at least a year after recovering from the acute illness to diagnose cardiovascular complications of the infection, which form part of long COVID.”

The occurrence of cardiovascular disease and death in infected versus uninfected individuals was analysed to ascertain the link. The data was obtained from individuals recruited before December 2020 when there were no vaccines available in the UK. The UK Biobank was used to gather information about more than 7500 COVID-19 patients diagnosed between 16 March 2020 and 30 November 2020.

Each of the COVID-19 cases was matched with up to 10 individuals without COVID-19 and a historical cohort from before the pandemic (16 March 2018 to 30 November 2018). The cohorts were matched for age, sex, smoking, diabetes, high blood pressure, cardiovascular and other health conditions, body mass index, ethnicity and deprivation. The average age across all three groups was 66 years, with an almost even mix of males and females.

Wong explained, “The historical control cohort was included to rule out the effect of routine healthcare services being reduced or cancelled during the pandemic, which led to worsening health and increased mortality even in uninfected people.”

Medical and death records were examined for instances of cardiovascular disease and conditions such as stroke, atrial fibrillation and myocardial infarction, and were evaluated for the acute phase (within 21 days of COVID-19 diagnosis) and the post-acute phase (starting at 22 days after diagnosis and continuing up to 18 months). The data revealed that patients with COVID-19 were approximately four times more likely to develop major cardiovascular disease in the acute phase and 40% more likely in the post-acute phase when compared with uninfected individuals.

Compared to uninfected individuals, the risk of death in COVID-19 patients was up to 81-fold higher in the acute phase and five-fold higher in the post-acute phase. Patients with severe COVID-19 were more likely to develop major cardiovascular disease or die than non-severe cases.

COVID-19 patients had a greater likelihood of several cardiovascular conditions compared with uninfected participants in both the short and long term including myocardial infarction, coronary heart disease, heart failure and deep vein thrombosis. Risks of some cardiovascular conditions — for example, stroke and atrial fibrillation — were elevated in COVID-19 patients in the short term but then returned to normal levels.

Wong said, “This study was conducted during the first wave of the pandemic, and future research should evaluate subsequent outbreaks. Previous research has indicated that COVID-19 vaccination may prevent complications, and further studies are needed to investigate its effectiveness in reducing the risks of cardiovascular disease and death after COVID-19 infection in patients with COVID-19 vaccination compared to those without vaccination.”

European Society of Cardiology spokesperson Professor Héctor Bueno of the National Centre for Cardiovascular Research (CNIC), Madrid, Spain, said, “COVID-19 has had a huge impact on patients with cardiovascular disease, who were less likely to receive optimal care during the pandemic and more likely to die from the infection. This study shows that COVID-19 also increases the risk of having cardiovascular complications and dying in the first weeks after the infection and remains high for months, suggesting that specific cardiovascular monitoring may be appropriate in these patients.”

Image credit: iStock.com/Adene Sanchez