12 Adjudicated myocarditis and multisystem illness trajectory in healthcare workers post-COVID-19

Introduction We aimed to understand the impact of being a healthcare worker on the progression and outcomes of illness in individuals hospitalised because of post-COVID-19 complications. Materials and Methods The CISCO-19 study included patients hospitalised with COVID-19 and assessed baseline characteristics at index and multi-system phenotyping 28–60 days following discharge from hospital. Our analysis sought to compare the health and recovery metrics of healthcare workers within this cohort against those of non-healthcare professionals, considering variables like age, gender, cardiovascular risk, and severity of inflammation. Results A total of 168 patients, 28–60 days post their last hospital care, were assessed. Among them, 36 identified as healthcare workers. Comparatively, healthcare workers were found to be predominantly of a similar age to non-healthcare workers but had a higher proportion of females. In adjusted multivariate logistic regression analysis, healthcare worker status associated with a binary classification (probable/very likely vs not present/unlikely) of adjudicated myocarditis (odds ratio: 2.99; 95% confidence interval (1.01, 8.89) by 28–60 days post-discharge. After a mean (SD, range) duration of follow-up after hospital discharge of 450 (88) days (range 290, 627 days), fewer healthcare workers died or were re-hospitalised (1 (3%) vs 22 (17%); p=0.038) and secondary care referrals for post-COVID-19 syndrome were common (42%) and similar to non-healthcare workers (38%; p=0.934). Discussion Almost one-quarter of the patients were healthcare workers and they were mostly women. Despite less severe acute illness and better antecedent health, compared with non-healthcare workers, healthcare workers had a 3-fold higher likelihood of adjudicated myocarditis, reflecting deep organ involvement of COVID-19. The aetiology of myocardial inflammation may be direct viral myocarditis or myocardial inflammation reflecting multisystem illness. Reverse causality may be relevant in that individuals with reasonably good background health have a greater reserve to withstand COVID-19 such that in those individuals who eventually become sufficiently unwell to require hospital care, the severity of COVID-19 is more pronounced. Healthcare workers have enhanced occupational exposure to SARS-CoV-2 in their workplace which may explain why healthcare workers had evidence of systemic involvement in deep organs, i.e., myocarditis, despite seemingly lower levels of systemic inflammation reflected by CRP. Conclusion Healthcare worker status was independently associated with the likelihood of adjudicated myocarditis, despite better antecedent health. Two in five healthcare workers had a secondary care referral for post-COVID-19 syndrome. Acknowledgements This was an investigator-initiated clinical study funded by the Chief Scientist Office of the Scottish Government (COV/GLA/Portfolio project number 311300). The funder had no role in the design, conduct (non-voting TSC member), data analysis and interpretation, manuscript writing, or dissemination of the results. C.B, C.D., N.S., R.M.T. were supported by the British Heart Foundation (RE/18/6134217). The MRI study involved technologies provided by Siemens Healthcare and the National Institutes of Health. HeartFlow (HeartFlow, Redwood City, CA) provided FFRCT. The study was co-sponsored by NHS Greater Glasgow & Clyde Health Board and the University of Glasgow.