COVID infection and long COVID substantially raise the risk for serious cardiovascular complications — including heart failure, arrhythmias, stroke, and thromboembolism — according to a clinical consensus statement from the European Society of Cardiology (ESC).

The report, published in the European Journal of Preventive Cardiology, states that long-term cardiovascular problems can emerge during acute illness and persist months to years afterward.

Researchers estimate up to 5% of all individuals infected with COVID, or approximately 5 million people globally, develop cardiac long COVID, characterized by chest pain, palpitations, breathlessness, fatigue, and, in some cases, autonomic dysfunction.

Even patients without prior heart disease face increased risks. Those hospitalized for COVID may carry nearly a fourfold risk for cardiovascular events for up to 3 years after infection, according to the report.

The consensus panel calls on clinicians to

• Educate patients early after acute infection to report cardiac symptoms promptly,
• Continue vaccination to lower the risks for cardiac complications and long COVID,
• Prescribe structured cardiac rehabilitation programs to restore cardiopulmonary function and reduce long-term morbidity, and
• Avoid routine prophylactic antiplatelet or anticoagulant therapywithout indication as evidence for prevention is lacking and bleeding risks are significant.

“COVID doesn’t only affect the lungs. It can damage the heart and blood vessels, both during acute infection and for months afterward,” lead author Vassilios Vassiliou, MD, clinical professor in Cardiac Medicine at the University of East Anglia in Cambridge, England, said in a written statement. “ This means chest pain, breathlessness, palpitations, or fatigue may be signs of cardiac long COVID. If you already have heart disease, COVID raises your risk of serious complications both immediately and long after infection. In both cases, rehabilitation can protect your heart and support recovery.”

William Schaffner, MD, professor of medicine and infectious diseases at Vanderbilt University Medical Center in Nashville, Tennessee, said the report should put cardiovascular risks from COVID “front of mind” for clinicians.

“It impressed me — and I’m pretty up to date in these things,” he said. “Putting it all together, it’s really very compelling that doctors should keep this range of cardiovascular events associated with COVID acutely and long term in mind when treating patients.”

Schaffner also said clinicians should use these findings to bolster vaccine counseling.

“Anybody who has any kind of cardiovascular disease, from atrial fibrillation to congestive heart failure to hypertension, is certainly eligible for the vaccine under FDA guidance,” he said. “The Advisory Committee on Immunization Practices has also stressed that it’s especially important for people in high-risk groups. We have quite permissive recommendations.”

Still, diagnosing cardiac long COVID can be challenging, Schaffner said, since symptoms like fatigue, chest pain, or palpitations overlap with other conditions. But he said a clear temporal link — when cardiac problems emerge during acute infection and persist afterward — can help clinicians make the connection.

“If congestive heart failure begins 3 months after you’ve recovered, the link is quite uncertain,” he said.

Both ESC experts and Schaffner emphasized standard cardiovascular risk management, such as addressing obesity, diabetes, hypertension, smoking, and inactivity, as essential in care after COVID infection.

“Attention to all of those things is an excellent idea,” Schaffner said. “Not only physically but mentally — encouraging gradual exercise, healthy eating, and good adherence to blood pressure treatment — remains central.”

No funding was received for this consensus statement. Vassiliou reported receiving speaker fees from Novartis and a grant for investigator-initiated research from B. Braun Ltd. Schaffner reported having no relevant conflicts of interest. 

Lara Salahi is a health reporter based in Boston.