OBJECTIVES: There is increasing evidence suggesting that patients with COVID-19 could experience cardiac manifestations, including heart failure (HF) and myocardial infarction (MI). We conducted a systematic review and meta-analyses to assess incidences of HF and MI post COVID-19 recovery.

METHODS: A comprehensive search was conducted across EMBASE and MEDLINE to identify studies published in English, reporting the incidence of HF/MI post COVID-19 recovery. Two reviewers independently screened the studies for inclusion. Data extraction was done in a pre-defined extraction grid by a single reviewer and validated by another reviewer. Studies were assessed for clinical and statistical heterogeneity. The incidence of HF/MI was combined using a random-effects model (REM). Study heterogeneity was quantified based on the subgroup and meta-influence analysis. All analyses were conducted using Stata v17.0.

RESULTS: Of the 912 studies screened, six population-based studies assessing 17,762,987 patients were included. A total of 1,530,882 patients (mean age:55 yrs.; 58% males) had confirmed COVID-19 infection, while 16,232,105 patients (mean age: 54 yrs.; 57% males) represented the control group. Based on a REM, the pooled incidence of post-COVID-19 HF was 0.016% (95% CI: 0.008, 0.023) and for MI was 0.005% (0.003, 0.007). A significant increase in the risk of developing HF (Risk ratio [RR], 95% CI: 2.96 [2.05, 4.26] p<0.0001, I-square=99%) and MI (4.39 [1.94, 9.95] p<0.0001, I-square=99%) was observed in COVID-19 group versus control. Based on the reported hazard ratios (HR), a 90% increase in the incidence of HF (HR [95% CI]: 1.90 [1.55, 2.35], p<0.0001, I-square=98%) and a 94% increase in the incidence of MI (1.94 [1.66, 2.28], p<0.0001, I-square=98%) was observed. Meta-influence analyses did not identify any outlier studies suggesting the base case results are robust to the variability in the baseline characteristics.

CONCLUSIONS: COVID-19 survivors showed an increased risk of developing HF and MI compared to non-COVID-19 controls.