Out of the Hospital, Not Out of the Woods

New research shows COVID-19 patients have a higher likelihood of heart failure post-discharge

A new study comparing discharged COVID-19 hospital patients to discharged patients who were hospitalized for other reasons showed the COVID patients were 45% more likely to experience heart failure within a year following their discharge.

Researchers from University of Arkansas for Medical Sciences, the Duke Clinical Research Institute (DCRI), the University of Colorado Center for Health AI, Palantir Technologies, Johns Hopkins University, the University of North Carolina and N.C. State University Joint Department of Biomedical Engineering examined the records of more than 250,000 hospitalized and discharged COVID patients with no history of heart failure. They compared the COVID patient follow-up records with more than 330,000 patients with no COVID-19 or history of heart failure.

The research, recently published in Nature Communications, resulted in one of the first publications using the National COVID Cohort Collaborative database, and expands on findings from a Veterans Affairs study showing heart failure risk increased in veterans after recovering from COVID-19.

Researchers using the National COVID Cohort Collaborative (N3C) database found that patients discharged from COVID-19 hospitalizations had higher incidence of heart failure after discharge, higher mortality rate and a higher incidence of death or heart failure. Notably, the “Post-recovery COVID-19 and incident heart failure in the National COVID Cohort Collaborative (N3C) study” showed that individuals who were younger (less than 65 years old), white, and those with established cardiovascular disease were disproportionately affected, showing a higher incidence of heart failure following COVID-19-related hospitalization and discharge.

“One reason for that is that this disease doesn’t discriminate in terms of age or comorbidities,” said Marat Fudim, MD, MHS, a cardiology faculty member in the DCRI and co-author of the paper. “We adjusted for comorbities, but still, despite adjustments, younger people were just as much if not more affected by the disease.”

Because this study only looked at patients who had faced the worst effects from COVID — whose illnesses were severe enough that they were hospitalized — what remains unknown is how many of the hundreds of millions of individuals who had COVID-19 with less severe symptoms may be at increased risk for cardiovascular issues.

“This is only hospitalized COVID — so this is the worst of the worst,” Fudim said. “So, the next time you go up a flight of stairs and you get a little short of breath, it’s maybe because you had (COVID), but you didn’t develop the full-blown COVID that gets you diagnosed with heart failure.”

Fudim pointed out that life expectancy in the United States has fallen due to the COVID-19 pandemic, but those figures do not yet account for the after-effects of the disease, which will hinder future life expectancy rates.

“Unlike other Western countries, the life expectancy in the United States fell — that is a direct effect of COVID mortality, but it does not yet account for the induced morbidity, which morbidity takes time to lead to mortality,” Fudim said. “So, the life expectancy curve will continue to stagnate or fall. It has to—that’s what our Nature Communications paper shows. The pandemic just kicked off a big wave.”