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Beyond recovery: long-term cardiovascular risks after severe COVID-19 requiring intensive care

Johanna Kämpe1, Martin Jonson2, Rebecka Rubenson Wahlin3,4

  • 1Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, 17177, Sweden. johanna.kampe@ki.se.

Critical Care (London, England)
|May 26, 2026
PubMed

Insights

Severe COVID-19 survivors requiring intensive care face a higher risk of atherosclerotic cardiovascular disease (ASCVD) and other cardiac issues for up to three years post-discharge. This increased risk includes heart failure and atrial fibrillation.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Severe COVID-19 is linked to acute cardiovascular complications.
  • Long-term cardiovascular outcomes post-critical care are not well-documented.

Purpose of the Study:

  • To assess the three-year risk of atherosclerotic cardiovascular disease (ASCVD) in severe COVID-19 survivors.
  • To evaluate secondary outcomes including heart failure, atrial fibrillation, and mortality.

Main Methods:

  • Nationwide, population-based matched cohort study using the Swedish Intensive Care Registry.
  • Included adults mechanically ventilated for COVID-19, discharged alive (March 2020 - June 2021).
  • 1:4 propensity score matching (cases vs. controls) for a three-year follow-up.

Main Results:

  • 16,530 individuals (3,350 COVID-19 survivors, 13,180 controls) were analyzed.
  • COVID-19 survivors showed increased risk for ASCVD (sHR 1.42), atrial fibrillation (sHR 1.85), and heart failure (sHR 1.81).
  • All-cause mortality was also significantly higher in survivors (HR 1.48).

Conclusions:

  • ICU-treated severe COVID-19 survivors have elevated risks of ASCVD, heart failure, and atrial fibrillation up to three years post-discharge.
  • These cardiovascular risks were most pronounced in the first year following critical illness.
  • The findings highlight the need for long-term cardiovascular monitoring in severe COVID-19 survivors.
Abstract

Keywords:
Atherosclerotic cardiovascular diseaseCardiovascular outcomesCovid-19Intensive care unitLong-term follow-upPropensity score matching

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