What does this research mean for the field?

COVID-19 infection is associated with a nearly threefold increase in the risk of incident myocarditis compared to non-COVID-19 respiratory infections. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Evaluate the incidence of myocarditis, acute myocardial infarction, and heart failure among hospitalized patients with COVID-19 compared to controls hospitalized for other respiratory illnesses.

February 3, 2022CureusOpen Access

COVID-19 Infection and Incident of Myocarditis: A Multi-Site Population-Based Propensity Score-Matched Analysis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: COVID-19 infection (n=298096). Intervention: COVID-19 infection vs. Respiratory illness without COVID-19 (pneumonia/influenza). Primary outcome: Incidence of myocarditis in the three months following hospitalization (OR 2.73, 95% CI 1.78-4.18).

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Key result

COVID-19 infection is linked to ~173% higher risk of incident myocarditis versus non-COVID pneumonia or influenza.

OR 2.73
95% CI 1.78-4.18
n=298,096

Why the study?

Population-level data were lacking regarding the relationship between COVID-19 infection and cardiovascular complications including myocarditis, acute myocardial infarction, and heart failure.

Does COVID-19 infection increase the risk of incident myocarditis compared to other respiratory illnesses in hospitalized adults?

Population

Patients ≥18 hospitalized with respiratory illness across 50 US health systems

Comparison

COVID-19 infection vs respiratory illness without COVID-19 in 2020 and 2019

Design

Retrospective propensity score-matched cohort study

Authors

SPShivani PriyadarshniThe University of Texas Medical Branch at Galveston JWJordan WestraThe University of Texas Medical Branch at Galveston KYKuo Yong-FangThe University of Texas Medical Branch at Galveston

Discussion

Member takes

Implication

May prompt closer myocarditis monitoring in hospitalized COVID-19; hypothesis-generating and requires prospective validation before practice change.

Key Points

Evaluate the incidence of myocarditis, acute myocardial infarction, and heart failure among hospitalized patients with COVID-19 compared to controls hospitalized for other respiratory illnesses.
Retrospective cohort study analyzing de-identified electronic records from 50 United States health systems among hospitalized patients aged ≥18.
Propensity score-matched hospitalized patients with COVID-19 in 2020 (N=107,699) to patients with non-COVID-19 respiratory illness in 2020 (N=77,499) and 2019 (N=112,898), excluding baseline cardiovascular disease.
New-onset myocarditis occurred in 79 (0.12%) patients with COVID-19 versus 29 (0.04%) control patients (OR 2.73, 95% CI 1.78–4.18).
Observed heart failure was lower in the COVID-19 group with 1,512 cases versus 2,659 in controls (OR 0.49, 95% CI 0.46–0.52).
Acute myocardial infarction occurred in 1,125 COVID-19 patients versus 1,243 control patients (OR 0.87, 95% CI 0.80–0.94).

Study Design

Type

Cohort (n=298,096)

Multicenter

Yes

Structured PICO

Does COVID-19 infection increase the risk of incident myocarditis compared to other respiratory illnesses in hospitalized adults?

Population

298,096 adults hospitalized for respiratory illness (COVID-19 or pneumonia/influenza) without prior cardiovascular events, followed for 3 months to assess incident myocarditis.

Exposure

COVID-19 infection (hospital admission for respiratory illness with COVID-19)

Comparator

Hospital admission for respiratory illness without COVID-19 (pneumonia/flu) in 2019 and 2020, matched by propensity score

Outcome

Incident myocarditishard clinical

Main Result

Odds Ratio: 2.73 (95% CI 1.78–4.18)

Absolute Event Rate: 0.12% vs 0.04%

COVID-19 infection is associated with a 2-3-fold higher risk of incident myocarditis compared to other respiratory illnesses, though HF and AMI diagnoses were paradoxically lower, likely due to diagnostic challenges and early mortality.

Limitations

Propensity score matching resulted in the loss of 30-40% of COVID-19 patients, potentially impacting generalizability.
Reliance on ICD-10-CM codes, which may not be entirely accurate or complete.
Lack of data on clinical signs and symptoms.
The TriNetX database may not fully represent the general U.S. population.
Lack of socioeconomic data and indicators of access to care.
severity of lung disease obscuring physical exam findings required for HF diagnosis
early mortality before a diagnosis of HF was made

Cite This Study

Priyadarshni et al. (2022) conducted a cohort in COVID-19 infection (n=298,096). COVID-19 infection vs. Respiratory illness without COVID-19 (pneumonia/influenza) was evaluated on Incidence of myocarditis in the three months following hospitalization (OR 2.73, 95% CI 1.78-4.18). COVID-19 infection was associated with a nearly 3-fold higher risk of incident myocarditis compared to non-COVID-19 pneumonia or influenza (OR 2.73).

synapsesocial.com/papers/6aa6368b3f91f0dc527905cf https://doi.org/10.7759/cureus.21879

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Implication

May prompt closer myocarditis monitoring in hospitalized COVID-19; hypothesis-generating and requires prospective validation before practice change.

COVID-19 Infection and Incident of Myocarditis: A Multi-Site Population-Based Propensity Score-Matched Analysis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

COVID-19 Infection and Incident of Myocarditis: A Multi-Site Population-Based Propensity Score-Matched Analysis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider