Cardiac symptoms persist in 10% of patients with long-term COVID

In a recent study published on medRxiv*preprint server, researchers described long-term heart symptoms associated with coronavirus disease 2019 (COVID-19).

Recent studies have shown that the long-term cardiac symptoms associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can persist for months or even years. Chest discomfort, inflammatory heart disease, and arrhythmia, among other symptoms, are commonly seen. Heart muscle inflammation, or myocarditis, which can be directly caused by a viral infection, can progress to manifest as subclinical or overt myocardial dysfunction with or without electrophysiological abnormalities with long-term consequences. The intensity and duration of these cardiac symptoms differ from patient to patient. Detecting its risk factors is an important and active area of ​​research that can inform the monitoring and treatment of these symptoms and reduce the burden of disease and eventual mortality in COVID-19 survivors.

To study: Long-term cardiac symptoms after COVID-19: a systematic review and meta-analysis. Image Credit: Kateryna Kon/Shutterstock

About the study

In the current study, researchers assessed and synthesized relevant information from studies describing the long-term cardiac symptoms observed after COVID-19.

The team conducted a systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviewers and Meta-Analysis) criteria. Long COVID-19 was described as symptoms lasting four weeks or more from the date of the tracking index, which included symptom onset, hospital admission, and hospital discharge. Additionally, the team performed the initial research on two preprint servers and seven electronic databases between January 1, 2020 and May 10, 2021. Covidence is a web-based collaborative software platform that facilitated the development systematic reviews and other reviews of the literature and was used for the article. screening procedure.

A modified version of the Newcastle-Ottawa Scale (NOS) was designed to assess the quality of seven items for each research, including sample size, representativeness of sampling, assessment of exposure, assessment of covariates, outcome evaluation, statistical analysis and follow-up. The quality of each item was assessed as “good”, “fair” or “poor”, and a score was determined. The team used R (version 4.2.2) for all analyses. The percentage of commonly observed cardiac symptoms was calculated as the proportion of COVID-19 survivors reporting a particular cardiac symptom out of the total proportion of COVID-19 survivors.

Results

This systematic review examined 101 studies related to long-term cardiac symptoms after COVID-19, 92 of which provided sufficient data for meta-analysis. These studies evaluated 49 distinct long-term cardiac symptoms seen after COVID-19, with chest discomfort and arrhythmia being the most commonly studied symptoms. More than two-thirds of all studies involved prospective cohorts, while 14 included retrospective research and 15 conducted cross-sectional research. Most of the research involved online surveys, regional studies, and studies of multiple hospitals or a single hospital.

About 60% of the studies had a sample size between 100 and 999 participants, while 28% involved a minimum of 1000 participants. The majority of studies have clinically confirmed SARS-CoV-2 infections. Long-term cardiac symptoms were clinically reviewed or self-reported. The index dates of the follow-up periods differed from one study to another. In addition, inpatients were recruited in 45 studies, outpatients in 15 studies, and both inpatients and outpatients in 35 studies. The majority of studies involved patients with COVID-19 of any severity, while the tools used to measure severity differed significantly.

Five or more studies have documented ten cardiac symptoms, including chest discomfort, arrhythmia, cardiac abnormalities, hypertension, myocardial damage, stroke, thromboembolism, heart failure, myocarditis and coronary diseases. For these symptoms, random-effects and fixed-effects meta-analyses were also performed. All symptoms showed significant variation between studies. A random-effects model described the pooled proportion of cardiac symptoms, including chest pain, hypertension, arrhythmia, cardiac abnormalities, thromboembolism, myocardial damage, stroke, coronary heart disease, myocarditis and heart failure.

After stratification, heterogeneity remained significantly high for most symptoms in the stratum. Studies with the lowest quality score, weakest sampling strategies, cross-sectional techniques, and smallest sample size indicated the highest prevalence of both symptoms. For example, the proportion of COVID-19 survivors who experienced chest discomfort ranged from 21.32% in low quality analyses, 9.26% medium quality, to 4.04% in high score analyses. quality. Similar trends were also observed for other symptoms; however, the low proportion of studies in some strata hampered formal analysis.

Conclusion

The study results highlighted a variety of cardiac symptom presentations seen after COVID-19, many of which could last for months or even a year. There is considerable variety in research design and significant variation in the proportion of symptoms reported by study characteristics. The researchers believe that the limitations of existing research are currently hampering better knowledge of the long COVID-19. The present research has demonstrated the need for high-quality studies of long-term COVID-19 and the need for long-term cardiac monitoring for COVID-19 survivors.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.