Beyond Acute COVID-19: A Review of Long-term Cardiovascular Outcomes

Statistics Canada estimated that approximately 1.4 million Canadians suffer from long COVID. Although cardiovascular changes during acute SARS-CoV-2 infection are well documented, long-term cardiovascular sequelae are less understood. In this review, we sought to characterize adult cardiovascular outcomes in the months after acute COVID-19 illness. In our search we identified reports of outcomes including car-diac dysautonomia, myocarditis, ischemic injuries, and ventricular dysfunction. Even in patients without overt cardiac outcomes, sub -clinical changes have been observed. Cardiovascular sequelae after SARS-CoV-2 infection can stem from exacerbation of preexisting con-ditions, ongoing inflammation, or as a result of damage that occurred during acute infection. For example, myocardial fibrosis has been re-ported months after hospital admission for COVID-19 illness, and might be a consequence of myocarditis and myocardial injury during acute disease. In turn, myocardial fibrosis can contribute to further outcomes including dysrhythmias and heart failure. Severity of acute infection might be a risk factor for long-term cardiovascular conse-quences, however, cardiovascular changes have also been reported in young, healthy individuals who had asymptomatic or mild acute dis-ease. Although evolving evidence suggests that previous SARS-CoV-2 infection might be a risk factor for cardiovascular disease, there is heterogeneity in existing evidence, and some studies are marred by measured and unmeasured confounders. Many investigations have also been limited by relatively short follow-up. Future studies should focus on longer term outcomes (beyond 1 year) and identifying the prevalence of outcomes in different populations on the basis of acute and long COVID disease severity.

Automated summary

Statistics Canada estimates that about 1.4 million Canadians have long COVID, with various cardiovascular outcomes such as cardiac dysautonomia, myocarditis, ischemic injuries, and ventricular dysfunction. These cardiovascular issues can result from acute infection-induced damage, ongoing inflammation, or preexisting conditions. Long-term cardiovascular consequences may not be limited to severe acute cases, as even young, healthy individuals with mild or asymptomatic illness have been reported to experience cardiovascular changes.