Does COVID increase the chance of heart failure and attacks?

Scientists in the US have found people who've had the virus are more likely to suffer heart failure and attacks — unlike Australian data so far.

Heart problems are one of the biggest killers in Australia — and not just for old people. They are one of the leading causes of death for those who would otherwise have plenty of life left. If you’re a man aged 45-54, the most likely thing to kill you is what they call “ischaemic heart disease”.

COVID is well known to affect the heart during acute infection — and leave it weakened.

“[A] significant proportion of those with prior COVID-19 infection also exhibit signs of cardiac damage,” write Corinna Serviente, Stephen Decker and Gwenael Layec in their 2022 paper, “From heart to muscle: pathophysiological mechanisms underlying long-term physical sequelae from SARS-CoV-2 infection“.

Was the death of Shane Warne earlier this year a forewarning of a wave of post-COVID heart attacks in men who’d rather grow old enough to meet their grandchildren? With the release of official Australian Bureau of Statistics data on causes of death in 2021, we finally have information on what is happening in Australia.

It looks concerning. The standardised death rate from heart diseases rose in 2021 compared with 2020. It rose for men who are particularly prone to severe COVID infections due to the higher prevalence of ACE-2 receptors in their body. But the standardised death rate for women rose even more.

What the chart above shows is that heart problems soared, but the chance of clutching your chest and falling to the floor did not. While heart disease is up, acute heart attacks are down. (Myocardial infarction is just a fancy phrase for a heart attack.)

It is important to understand what the graph above shows: a standardised death rate.

Calculating a death rate is a way of accounting for the fact we have a larger population each year. You’d expect the raw number of deaths by heart attack to rise each year; using a rate controls for that. Standardising that rate is a way of accounting for the ageing population.

We have more old people each year. You’d expect the raw number of deaths by heart attack to rise as the population gets older, but if the risk in each age group isn’t changing, you want the standardised death rate to stay the same.

Of course, comparing 2021 with 2020 could be misleading; 2020 was a year with very few deaths. If we look at the bigger picture, we find something interesting. As the next chart shows, ischaemic heart disease deaths and heart attack deaths are falling over time. This makes the change in 2021 a little more concerning — it occurs against a backdrop of decline. Other forms of heart disease have been pretty stable recently before rising in 2021. Also concerning.

But this data is from 2021, and won’t contain all the December deaths from the COVID waves that hit Australia in 2021. The data shows deaths reported last year, not deaths that occurred last year.

What do we see if we look at newer data? The Actuaries Institute has been diving into the latest data and analysing it against its expectations of how many people would usually die of heart problems. It finds a 12% increase in deaths from ischaemic heart disease so far in 2022.

As the next chart shows, deaths from heart disease are clearly above their estimated baseline.

This matches data from the US, where COVID was much more prevalent much earlier and where heart disease has also risen. Scientists find people who had COVID are more likely to have heart failure and (in contrast to Australian data so far) heart attacks.

Scientists warn of “a substantial increase in global cardiovascular disease burden as SARS-CoV-2 continues to spread throughout the population”.

It seems likely cardiovascular doctors of Australia will be very busy in 2022 and beyond.

So what can be done?

Scientists don’t have specific recommendations yet, but the risk factors for heart problems remain relevant. If you’ve had COVID and never done a spot of exercise in your life — or if you smoke — it could be time to finally make a lifestyle change.

Are you concerned about the after-effects of COVID? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name to be considered for publication. We reserve the right to edit for length and clarity.