EXECUTIVE SUMMARY
People with COVID-19 are at greater risk of cardiovascular disease, even after a year of observation, researchers found.
- COVID-19 placed people at greater risk of fast or slow heart rates, heart attacks, heart failure, vascular disease, strokes, and ischemic attacks.
- Some people who recovered from COVID-19 developed blood clots in their legs,, which could lead to pulmonary embolism.
- Anyone who contracted COVID-19 was at higher risk, but those who were in the ICU were at the highest risk.
Even 30 days post-infection, people with COVID-19 are at increased risk of cardiovascular disease, including heart failure and thromboembolic disease, researchers found.1 Case managers and healthcare providers across the care continuum will need to consider a past bout with COVID-19 as a new risk factor for heart problems.
“We’ve been dealing with the pandemic for a little more than two years, and we’ve noticed that after people get COVID-19, they are coming back to the clinic with heart problems,” says Ziyad Al-Aly, MD, director of the Clinical Epidemiology Center and chief of research and development at VA St. Louis Healthcare System. Al-Aly also is a clinical epidemiologist at Washington University in St. Louis. “We wanted to understand whether we have a skewed view of this or if it is happening on a massive scale to people who had COVID-19. We looked at 153,000 people and 11 million controls, and we found these patients had higher risk of heart problems.”
These problems included fast heart rates, slow heart rates, heart attacks, heart failure, vascular disease, strokes, and ischemic attacks.
“Some people had blood clots in the legs, and sometimes those blood clots would go into the lungs and cause pulmonary embolism,” Al-Aly explains. “Even after a year of observation for these patients, people with COVID-19 were having significantly higher risk of heart problems.”
When 150,000 people are compared with 11 million controls and these findings result, it is compelling evidence, Al-Aly adds.
“What we found was that even those who didn’t get hospitalized had high risk,” he says. “But those who were hospitalized or who were in the ICU had really high risk.”
Assess for Risk Factors
As the pandemic ebbs, case managers and providers may need to develop tactics for following up with patients who were hospitalized with COVID-19 to ensure they are receiving primary care that pays close attention to their heart health.
“Those who were hospitalized or in the ICU for COVID-19 have exceptionally high risk of developing heart problems as a result of COVID-19,” Al-Aly explains. “They manifested with exceptionally high risk of cardiovascular conditions a year out.”
When providers see patients with a history of hospitalization for COVID-19, they should assess the patients for risk factors for heart conditions and ensure they are diagnosed early on and treated aggressively.
“Watch them like a hawk for chest pain, stress,” Al-Aly suggests. “That’s going to be important from a care management perspective.”
The VA health system uses post-COVID-19 clinics. This is a great idea for all health systems as well, he adds.
“All health systems should have post-COVID care pathways,” Al-Aly says. “There’s unlikely to be one size that fits all of these nationwide.”
Patient populations vary, and post-COVID-19 care should be designed according to those differences. Generally, post-COVID-19 care should be patient-centric, considering each patient’s long-term health concerns that may be related to their previous infection.
“Those who had COVID-19 are advised to be cared for in the post-COVID clinic, especially if they have manifestations like brain fog, fatigue, kidney disease, or diabetes after COVID,” Al-Aly says. “Heart disease is not the only thing that can go wrong.”
Clinical care pathways can direct patients through the healthcare system and address any problems that arise after COVID-19.
Some clinicians might ask why a post-COVID-19 clinic is necessary when these patients could be treated by their primary care providers. The answer is that health systems with post-COVID-19 clinics are improving care through branding, Al-Aly says.
“A lot of times, it’s branding it as post-COVID care,” he explains. “It tells patients, ‘I see you. I hear you. I recognize your problem. I acknowledge your problem.’”
When patients enter the healthcare maze, they may be unsure whether their physician is familiar with long COVID symptoms, or even whether the doctor believes there is such a thing. Then, they may be referred to other providers for certain symptoms and get lost in the shuffle.
“Health systems should be prepared to have clear and clearly branded post-COVID or long-COVID pathways,” Al-Aly says. “This orients patients, telling them where they go for help. ‘You may not get all the answers there, but here’s your hub, and you’ll be cared for by people who understand your condition.’”
That is enormously important to patients with a complex condition like long COVID. “Medicine is about healing,” Al-Aly says. “If we’re truly intending to heal people and give them care, the first thing is to recognize them.”
A post-COVID-19 clinic provider can connect all the dots for patients, helping them understand their condition and helping them reduce frustration and feeling as if the health system is not responding to their needs.
Referrals to post-COVID-19 clinics can come from the health system or community providers. Case managers can address the referral with patients during discharge planning.
“This is ongoing and it’s evolving; it’s in the embryonic stage,” Al-Aly says. “The whole idea of a post-COVID clinic is brand new, and we’re learning as we go in setting this up and trying to educate the workforce.”
For example, a post-COVID-19 interest group, conferences, or an innovation hub could be used to educate nurses, physicians, and others in healthcare about health problems that occur among people who have had COVID-19.
“It’s all new to us that it can lead to a long-term manifestation like heart disease,” Al-Aly says. “We didn’t know this a year ago; we’re learning as we go, and acting on new evidence.”
The VA’s post-COVID-19 clinic can see people for in-person visits and virtual visits. A patient’s first visit is in person, but follow-up visits could be scheduled to be virtual, depending on the patient’s preference.
“Some people live 30 to 40 miles away, and they may opt for virtual visits because they could do this from their couch and their laptop,” Al-Aly says.
REFERENCE
- Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med 2022;28: 583-590.
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