Acute Cardiovascular Events After COVID-19 in England in 2020: A Self-Controlled Case Series Study

Jennifer A Davidson,1 Amitava Banerjee,2 Helen Strongman,1 Emily Herrett,1 Liam Smeeth,1 Judith Breuer,3 Charlotte Warren-Gash1 1Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; 2Institute of Health Informatics, University College London, London, UK; 3Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UKCorrespondence: Charlotte Warren-Gash, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK, Tel +44 20 7927 2796, Email charlotte.warren-gash1@lshtm.ac.ukPurpose: To assess the risk of incident cardiovascular outcomes after COVID-19 by level of cardiovascular risk in waves one and two of the pandemic in England in 2020.Patients and methods: We conducted a self-controlled case-series study among adults aged 40– 84 years with no pre-existing cardiovascular disease using linked data from the Clinical Practice Research Datalink. We generated season-adjusted incidence ratios (IRs) for first acute cardiovascular event after SARS-CoV-2 infection compared with baseline time before and > 91 days after infection. We used composite and individual acute cardiovascular event outcomes including myocardial infarction, major ventricular arrhythmia, left ventricular heart failure, and ischemic stroke. We stratified by cardiovascular risk, using diagnosed hypertension and QRISK3 predicted risk, and by wave one and two of the pandemic.Results: We included 1762 individuals, 76.6% had a QRISK3 score ≥ 10% and 59.4% had hypertension. The risk of any cardiovascular event was elevated in the 1– 7 days after infection (IR 7.14 [95% CI 6.06– 8.41]) and, while the effect size tapered, the risk remained for 15– 28 days after infection (1.74 [1.33– 2.26]). Risks were similar for individual event type, differing by level of cardiovascular risk, and i