Elevance Health study links heart problems to long COVID

Patients who contract severe COVID-19 are much more likely to suffer from long COVID a year later compared to those who’ve not had the disease, and their condition often manifests itself as an increased risk of cardiovascular conditions as well as death, according to a study in JAMA Health Forum.

Researchers at insurer Elevance Health compared 13,435 individuals with long COVID, referred to as post-COVID-19 condition (PCC) in their case control study, with 26,870 individuals with no evidence of long COVID symptoms.  

Andrea DeVries, Ph.D., staff vice president for health services research at Elevance Health, told Fierce Healthcare in an email that “the biggest takeaway is that long COVID is a health condition that we need to continue to study and take seriously.

"We were particularly troubled by the elevated mortality risks for individuals with long COVID," DeVries said.

The study found that previous literature on the subject cites fatigue, headache, and attention disorder as common symptoms of PCC, but the Elevance study also found a statistically significant increased risk of heart problems and mortality.

The researchers also warned that the problem might be worse than their data indicated, saying that while the risk of cardiovascular problems and death were “heightened for individuals who experienced a more severe acute episode of COVID-19 (ie, requiring hospitalization), it is essential to note that most individuals (72.5%) in the cohort did not experience hospitalization during the acute phase. Many of these conditions will have lasting effects on quality of life.”

DeVries said that “we believe that to address a problem you have to understand its impacts. This study gives us valuable understanding as we continue to tailor our support for individuals who have lasting needs related to COVID-19.”

The JAMA Health Forum study joins the growing literature connecting long COVID to cardiovascular problems.

Last week, Fierce Healthcare reported on a study in Nature Medicine conducted by the U.S. Department of Veterans Affairs that reached a similar conclusion when crunching data on about 153,000 individuals, citing dysrhythmia as the most common individual outcome seen in those patients.

The Elevance study compared adults with claims of suffering from PCC with a control group who’d shown no evidence of having contracted COVID-19 from April 1, 2020, to July 31, 2021.

“During the 12-month follow-up period, 2.8% of the individuals with PCC vs 1.2% of the individuals without COVID-19 died, implying an excess death rate of 16.4 per 1000 individuals,” the study said.

Elevance started with a pool of 249,013 individuals 18 and older who had been diagnosed with COVID-19. They used codes for long COVID included in a medical claim and based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes for COVID-19—U071, B342, B9721, B9729, and J1281.

Researchers developed a claims-based definition of PCC based on descriptions by the Centers for Disease Control and Prevention. The CDC said that for individuals with PCC “conditions can include a wide range of ongoing health problems; these conditions can last weeks, months, or years.”

The Elevance study’s PCC group included individuals who had been diagnosed with COVID-19 or exhibiting COVID-19 symptoms during more than one visit to a provider from weeks 5 to 12 after the index date.

In the follow-up period, researchers found a consistent elevation in PCC outcomes in the group that had suffered from severe COVID. They included cardiac arrhythmias (29.4% post-infection vs. 12.5% pre-infection), pulmonary embolism (8% vs. 2.2%), ischemic stroke (3.9% vs. 1.8%), coronary artery disease (17.1% vs. 9.6%), heart failure (11.8% vs. 6%), COPD (32% vs. 16.5%), asthma (24.2% vs. 12.4%).

“With regard to mortality, 2.8% of the PCC cohort vs 1.2% of [the cohort of those who hadn’t contracted COVID] died during the follow-up period,” the study said. “This difference implies an excess death rate of 16.4 per 1,000 individuals.”

DeVries said that “based on the study, individuals diagnosed with long COVID were more than twice as likely to need care for cardiovascular events and 3.64 times more likely to have a pulmonary embolism. This study found that long COVID could have lasting effects on the quality of life.”

Elevance researchers noted that some prior studies also link long COVID with increased risk of heart problems, but their study “revealed numbers substantially higher than earlier reports for several reasons: a focus on PCC, the ability to evaluate data comprehensively across all care settings, comprehensive mortality information, and a 12-month follow-up period.”

Researchers also said that cardiovascular, pulmonary and mortality outcomes can be easily captured by claims data and that providers need to know as much as possible about these individuals.

“Gaining additional insight into the risks and trajectory of the disease is essential for clinicians caring for these individuals, especially a need for primary prevention for individuals at higher risk,” the study said. “At a health-systems level, it is also necessary to develop resources and guidance for individuals at risk for serious complications.”

For example, the study found, early results of the study prompted Elevance Health to develop a care management program for individuals identified as being at risk for long COVID.

“From a health policy perspective, these results also indicate a meaningful effect on future health care utilization, and even potential implications for labor force participation,” the study said. “Gaining knowledge on the scope and trajectory of PCC is relevant for policymakers, given the recent guidance by the US Department of Health and Human Services that classifies ‘long COVID’ as a disability if it substantially limits major life activities.”