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

Background/Introduction Severe COVID-19 is associated with cardiovascular complications in the acute phase, but the long-term cardiovascular consequences remain less explored. Knowledge of post–intensive care cardiovascular risk is important for guiding follow-up and preventive strategies. Purpose To evaluate the 3-year risk of atherosclerotic cardiovascular disease (ASCVD) and other cardiovascular outcomes among adults who survived severe COVID-19 requiring intensive care, compared with matched controls. Methods This nationwide, population-based matched cohort study included 3 years of follow-up. Adults treated in intensive care units (ICUs) between March 1, 2020, and June 8, 2021, were identified and followed from 30 days after ICU discharge through 3 years. The study was conducted in Sweden using linked mandatory health and population registries. Adults with confirmed COVID-19 requiring mechanical ventilation in an ICU who were discharged alive (cases) were identified from the Swedish Intensive Care Registry. Population-based controls without ICU-treated COVID-19 were selected from the Swedish Population Register. Cases and controls were matched 1:4 using propensity scores including age, sex, district of residence, socioeconomic factors, and preexisting comorbidities. The final matched cohort included 3,223 cases and 12,892 controls. Median age was 60 years, and 71% were male. The exposure was admission to an ICU for COVID-19 requiring mechanical ventilation. The primary outcome was incident ASCVD, defined as ischemic heart disease or ischemic stroke, occurring more than 30 days after ICU discharge. Secondary outcomes included hospitalization for heart failure, atrial fibrillation, and all-cause mortality. Results Compared with controls, ICU-treated COVID-19 survivors had higher odds of ASCVD (OR, 1.62 [95% CI, 1.40–1.88]). Higher odds were also observed for hospitalization for heart failure (OR, 2.10 [95% CI, 1.76–2.51]), atrial fibrillation (OR, 1.95 [95% CI, 1.66–2.29]), and all-cause mortality (OR, 1.63 [95% CI, 1.35–1.98]). Excess cardiovascular events occurred primarily within the first year after ICU discharge. Conclusion Survivors of severe COVID-19 requiring intensive care had increased odds of major cardiovascular events and mortality during 3 years of follow-up. These findings suggest sustained cardiovascular vulnerability after critical COVID-19 and support targeted cardiovascular surveillance in this high-risk population.