What we know about the effects of COVID-19 on the heart
COVID-19 continues posing unforeseen challenges that can lead to lasting effects on patients. While some patients may have complete resolution of signs and symptoms of the coronavirus after diagnosis, others may experience future complications.
Pre-existing cardiovascular comorbidities can heighten risk of severe illness from COVID-19
According to the Centers for Disease Control and Prevention (CDC), coronary heart disease (CHD) is the most common type of heart disease. Other common types of heart disease include heart failure, cardiomyopathy, arrythmias (such as tachycardia or atrial fibrillation), murmurs, aneurysms, angina and many others. Each of these cardiac conditions, along with COVID-19, poses a unique risk to a patient’s health and well-being that should be evaluated on a case-by-case basis.
COVID-19 may have a significant, possibly long-term impact on the heart
Although any COVID-19-positive patient can potentially develop a heart condition, patients at high risk of experiencing adverse outcomes include those with preexisting conditions such as hypertension, obesity, high cholesterol, heart failure (HF), and diabetes. It is estimated that about one-quarter of hospitalized patients with severe COVID-19 experience myocardial injury and can further develop arrhythmias or thromboembolic disease. A study published in the Journal of the American College of Cardiology (ACC) concluded that, “among patients with chronic HF hospitalized with COVID-19, nearly one in four died in-hospital.”
Unfortunately, when patients are discharged from the hospital or other medical facilities and are not adequately monitored, it is often difficult to determine whether their lungs are still weak from the infection or if they are truly having a heart-related issue on exertion. A recent cohort study published in JAMA Cardiology revealed, “cardiac involvement in 78% of patients and ongoing myocardial inflammation in 60%, independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis.” A JAMA Network study showed that, “even sixty days after onset of first COVID-19 symptoms, a high proportion of patients still reported fatigue (53.1%), dyspnea (43.4%) and chest pain (21.7%).” Self-care and follow-up monitoring such as making and keeping appointments, tracking symptoms, and maintaining physical activity is critical for these patients’ continued health goals.
There are many theories on how COVID-19 affects the cardiovascular system. Overall, SARS-CoV-2, the infectious viral agent, can cause widespread, multifactorial inflammation throughout the body. More specifically, it can exacerbate an inflammatory plaque rupture, worsen microvascular dysfunction and trigger a stent thrombosis. In addition, the virus can increase cardiac stress due to high cardiac output, invade the angiotensin-converting enzyme 2 (ACE2) receptor cells causing systemic endothelitis and infiltrate interstitial mononuclear inflammatory cells.
With such a complex viral attack on the body from COVID-19, long-term research is needed to better understand ways to avoid preventable cardiovascular complications associated with COVID-19. Veradigm®, an Allscripts company, has de-identified ambulatory data and next-generation solutions that can help facilitate research and analysis for the further understanding of the links between heart disease and COVID-19. This also provides patients at increased risk for preventable complications an opportunity to receive detailed information on their medical condition or to enroll in a clinical trial. Through its partnership with the American College of Cardiology, Veradigm will operate the PINNACLE Registry®, which focuses on coronary artery disease, hypertension, heart failure and atrial fibrillation.
Allscripts is committed to promoting awareness for American Heart Month in February. We remain dedicated to the mission of ensuring patients and providers alike are washing their hands regularly, maintain safe distances and wearing face masks to limit the spread of COVID-19.