Patients with mild COVID-19 infection managed solely in an outpatient forum face a significantly lower risk for experiencing and being hospitalized for a post-COVID-19 cardiovascular event (CVE) than patients with COVID-19 who are hospitalized or required critical care, according to study findings published in Clinical Infectious Diseases.

Investigators sought to assess the relationship between COVID-19 severity and the subsequent risk for experiencing a CVE following COVID-19 recovery.

They initiated a retrospective cohort study analyzing insurance claims data from the HealthVerity Real-Time Insights and Evidence database that included 1,357,518 adult patients in the US diagnosed with COVID-19 from April 2020 through May 2021. Included patients had at least 1 year of continuous medical and pharmacy coverage before index.

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The researchers calculated stabilized inverse probability of treatment weights to assess the association between COVID-19 severity and risk of CVE more than 30 days following a COVID diagnosis. They based severity on level of care patients required for COVID-19 treatment (outpatient care only, non-ICU hospitalization, intensive care unit [ICU] admission).

The primary outcome was first occurrence of thrombotic disorders, ischemic heart disease, dysrhythmia, stroke, or other cardiac disorders.

The investigators found that 95% of all patients were treated as outpatient only, 3% required non-ICU hospitalization, and 2% needed treatments in the ICU. Outpatients tended to be younger than patients requiring hospitalization, and had a lower prevalence of obesity, hospitalization in the previous year, diabetes without complications, and chronic kidney disease or end-stage renal disease.

There was an increased risk for any CVE for patients requiring non-ICU hospitalization for COVID-19 infection (adjusted hazard ratio [HR], 1.28; 95% CI, 1.24-1.33) and for patients admitted to the ICU (HR, 1.80; 95% CI, 1.71-1.89) compared with COVID-19 outpatients. The investigators noted the risk for subsequent CVE hospitalization was also higher in this group (HR, 1.96; 95% CI, 1.85-2.09 for non-ICU hospitalized patients vs outpatient only; HR, 3.47; 95% CI, 3.20-3.76 for ICU admission vs outpatient only).

Study limitations include the lack of a COVID-19 negative control group and lack of generalizability to reflect CVE exacerbation risk for pre-existing cardiovascular conditions or death within 30 days of diagnosis. Additionally, there is residual or unmeasured confounding.

COVID-19 patients hospitalized or requiring critical care had a significantly higher risk of experiencing and being hospitalized for post-COVID-19 CVE than patients with milder COVID-19 who were managed solely in the outpatient setting even after adjusting for differences between these groups,” the study authors wrote. “These findings underscore the continued importance of preventing SARS-CoV-2 infection from progressing to severe illness to reduce potential long-term cardiovascular complications.”

Disclosure: This research was supported by Pfizer, Inc. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Wiemken TL, McGrath LJ, Andersen KM, et al. COVID-19 severity and risk of subsequent cardiovascular events. Clin Infect Dis. Published online August 19, 2022. doi:10.1093/cid/ciac661

This article originally appeared on The Cardiology Advisor