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Incidence and individual risk prediction of post-COVID-19 cardiovascular disease in the general population: a
Hannah M la Roi-Teeuw1, Maarten van Smeden2,3, Geert-Jan Geersing1
1Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands.
Insights
Cardiovascular risks, including blood clots and atrial fibrillation, increase within 60 days post-COVID-19 infection. While prediction models show high accuracy, absolute risks remain low, limiting individual risk management guidance.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Previous research indicates a heightened cardiovascular risk following COVID-19 infection.
- Understanding the precise timing and magnitude of these risks is crucial for patient management.
Purpose of the Study:
- To assess the incidence of cardiovascular disease after COVID-19 infection.
- To explore individual risk factors and the temporal relationship of cardiovascular events post-COVID-19.
Main Methods:
- Utilized the UK's Clinical Practice Research Datalink for data extraction.
- Estimated incidence rates for arterial/venous events, inflammatory heart disease, atrial fibrillation, and heart failure within 180 days post-infection.
- Developed and externally validated multivariable logistic regression models in large vaccinated and unvaccinated cohorts.
Main Results:
- Observed increased incidence rates for venous/arterial cardiovascular events and new-onset atrial fibrillation up to 60 days post-COVID-19.
- Highest incidence rate noted for venous events (13 per 1000 person-years).
- Prediction models demonstrated high discriminative performance (c-statistics ≥0.90), but <5% of individuals had a predicted risk >1% at 180 days.
Conclusions:
- COVID-19 infection elevates the risk of arterial/venous cardiovascular events and new-onset atrial fibrillation within 60 days.
- Despite high model discrimination, the low absolute risk complicates individual risk stratification and management decisions.
Aims:
Previous studies suggest relatively increased cardiovascular risk after COVID-19 infection. This study assessed incidence and explored individual risk and timing of cardiovascular disease occurring post-COVID-19 in a large primary care database.
Methods And Results:
Data were extracted from the UK's Clinical Practice Research Datalink. Incidence rates within 180 days post-infection were estimated for arterial or venous events, inflammatory heart disease, and new-onset atrial fibrillation or heart failure. Next, multivariable logistic regression models were developed on 220 751 adults with COVID-19 infection before 1 December 2020 using age, sex and traditional cardiovascular risk factors. All models were externally validated in (i) 138 034 vaccinated and (ii) 503 404 unvaccinated adults with a first COVID-19 infection after 1 December 2020. Discriminative performance and calibration were evaluated with internal and external validation. Increased incidence rates were observed up to 60 days after COVID-19 infection for venous and arterial cardiovascular events and new-onset atrial fibrillation, but not for inflammatory heart disease or heart failure, with the highest rate for venous events (13 per 1000 person-years). The best prediction models had c-statistics of 0.90 or higher. However, <5% of adults had a predicted 180-day outcome-specific risk larger than 1%. These rare outcomes complicated calibration.
Conclusion:
Risks of arterial and venous cardiovascular events and new-onset atrial fibrillation are increased within the first 60 days after COVID-19 infection in the general population. Models' c-statistics suggest high discrimination, but because of the very low absolute risks, they are insufficient to inform individual risk management.
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