Five-year cardiovascular outcomes following COVID-19-associated carditis

Carditis (myocarditis, pericarditis, and endocarditis) is a rare but serious complication of SARS-CoV-2 infection. While COVID-19 has been associated with heightened long-term cardiovascular risk, the long-term prognosis of survivors with clinically confirmed carditis remains poorly characterized.

In this observational cohort study, we analyzed electronic health records from the Montefiore Health System (2016-2024) to evaluate long-term outcomes of patients who developed carditis during COVID-19. We compared three groups: COVID+ patients with carditis within 30 days of infection (n = 226), COVID+ patients without carditis (n = 42,758), and pre-pandemic carditis controls (n = 2107). Major adverse cardiovascular events (MACE) and all-cause mortality 30 days to up to 5 years post index were assessed using multivariate Cox regression adjusted for demographics, comorbidities, and social determinants.

Over a median follow-up of 22 months, COVID+  carditis+  patients had a significantly higher risk of MACE compared to COVID+  carditis- patients (adjusted HR 2.99 [95% CI 2.18, 4.10]) and higher all-cause mortality than pre-pandemic carditis + patients (adjusted HR 2.75 [1.93, 3.91]). Among COVID+  patients, myocarditis cases exhibited the lowest left ventricular ejection fraction and highest troponin elevations during acute illness, followed by patients with endocarditis and then pericarditis.

Survivors of COVID-19-associated carditis are at higher risk of all-cause mortality than non-COVID-19 carditis patients and at higher risk of MACE than non-carditis COVID-19 patients up to 5-year follow-up. These findings highlight the need for longitudinal surveillance and tailored cardiovascular care in survivors of COVID-19-associated carditis.