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COVID-19 Hospitalization May Increase Heart Failure Risk


3D illustration of coronavirus disease affecting the heart.

3D illustration of coronavirus disease affecting the heart. (Kateryna Kon, Shutterstock)

Mounting evidence links COVID-19 to cardiovascular inflammation and subsequent heart tissue damage. Damaged tissue can lead to heart failure, a condition in which a weakened heart cannot pump enough blood to meet the body’s needs. Even before the pandemic, heart failure was a leading cause of hospitalization and health care costs and a contributing factor to 1 in 8 deaths in the United States.

A large retrospective study powered by patient data from the National COVID Cohort Collaborative (N3C) highlights how severe SARS-CoV-2 infection may lead to more heart failure cases. The N3C data revealed that people hospitalized with COVID-19 were more likely to develop heart failure during their recovery than people without COVID-19 who were hospitalized.

Researchers from the University of Arkansas and Duke University and their colleagues examined electronic health records in the N3C database from more than half a million people. They compared heart failure outcomes between 257,075 people hospitalized with COVID-19 and 330,255 people who were hospitalized without COVID-19 from March 2020 to March 2022.

A greater percentage of the people who had COVID-19 in the hospital later developed heart failure (2.3%) than people who did not have COVID-19 (1.5%). Among those who later developed heart failure, those recovering from COVID-19 also developed the condition faster — 69 days after hospital discharge, compared with 84 days among those without COVID-19.

Even after the researchers adjusted for other risk factors, COVID-19 boosted the chance of post-hospitalization heart failure. Accounting for such factors as age, race, sex, use of cardiovascular medications and preexisting heart failure indicators, people hospitalized with COVID-19 were still 51% more likely than people hospitalized without COVID-19 to later develop heart failure. Those people who were white, were 65 years or younger, or took cardiovascular medicines faced even greater risks of heart failure after hospitalization.

What may link COVID-19 and heart failure? The researchers point to COVID-19’s tendency to promote blood clotting and trigger damage to the lining of blood vessels. Those effects could lead to blockages in the heart’s own blood vessels and thus to cardiac dysfunction. Over time, the result could be increased risk of heart failure.

Given the study’s findings, the researchers recommend that clinicians consider the potential for heart failure in any patient who shows respiratory or cardiac symptoms after hospitalization with COVID-19.

Learn more about the N3C study findings in Nature Communications.