Beyond recovery: long-term cardiovascular risks after severe COVID-19 requiring intensive care

Background: Severe Covid-19 has been associated with acute cardiovascular complications, but data on long-term cardiovascular outcomes after critical care are limited. This study aimed to evaluate the risk of atherosclerotic cardiovascular disease (ASCVD) within three years following severe COVID-19 requiring intensive care. Methods: This nationwide, population-based matched cohort study included adults with confirmed COVID-19 who required mechanical ventilation in the intensive care unit (ICU) and were discharged alive from the hospital between March 1, 2020, and June 8, 2021, identified from the Swedish Intensive Care Registry. After a 1:4 propensity score match including age, sex, district of residence, comorbidities and socioeconomic factors - cases and controls were compared regarding cardiovascular outcomes during a three-year follow-up. The primary outcome was ASCVD events occurring more than 30 days after discharge from the ICU and secondary outcomes included hospitalization for heart failure, atrial fibrillation, and all-cause mortality. Results: After propensity score matching, 16,530 individuals (3,350 cases and 13,180 controls) were included. The median age was 61 years, and 71% were male. Compared with controls, cases had an increased risk for ASCVD [subdistribution hazard ratio (sHR) 1.42 (95% CI 1.26-1.60)], hospitalization with atrial fibrillation [sHR 1.85 (95% CI 1.64-2.10)] and heart failure [sHR 1.81 (95% CI 1.57-2.09)]. All-cause mortality [hazard ratio (HR) 1.48 (95% CI 1.26-1.74)] was also significantly more frequent among cases. Conclusion: Among ICU-treated survivors of severe COVID-19, the risk of ASCVD, heart failure, atrial fibrillation, and all-cause mortality was increased during three years of follow-up compared with the matched population-based controls, with associations strongest during the first year of follow-up [period-specific estimates are provided in the Supplementary].