Reduce COVID-19 Cardiovascular Harm with New Guidance

Millions of people around the world are suffering from the serious cardiovascular effects of COVID infection and long COVID. A lack of clear guidance on how to reduce this suffering and prevent further harm means that patients are not receiving the care they need, and some are turning to unproven or unsafe treatments.

A major report published in the European Journal of Preventive Cardiology, sets out how to address this growing problem through diagnosis, treatment, rehabilitation and vaccination.

The report is a clinical consensus statement authored by a group of experts from across Europe, led by Professor Vassilios Vassiliou from University of East Anglia and Norfolk and Norwich University Hospital, UK, on behalf of the European Society of Cardiology (ESC).

Professor Vassiliou said, "COVID-19 has a profound and lasting impact on cardiovascular health, with complications emerging during acute illness, recovery, and even after reinfections or vaccination. In the absence of clear evidence-based guidance, patients risk harmful treatments and clinicians face uncertainty.

"This statement provides unified, practical recommendations for prevention, rehabilitation, and long-term care, while also identifying critical research gaps to ensure strategies continue to evolve with emerging evidence."

To prepare the report, the expert group reviewed all the existing research on COVID-19 and cardiovascular disease, including the effects of an acute infection, long COVID and COVID vaccination. They used this research to agree a set of recommendations on how to treat or prevent the damaging cardiovascular effects of COVID.

Almost one billion people are known to have been infected with COVID-19 worldwide, although the true number is believed to be far higher, and research shows that COVID patients, especially those who needed hospital treatment, have a higher risk of cardiovascular disease, including heart attack, stroke and death from cardiovascular disease.

Researchers estimate that around 100 million people are currently living with long COVID, and about 5% of these (five million) will have cardiac long COVID, with symptoms including angina (chest pain), breathlessness, arrhythmia (abnormal heart rhythm), heart failure, fatigue and dizziness. Long COVID can also lead to autonomic dysfunction where the nerves that normally control heart rate, breathing and body temperature do not work properly.

The expert consensus statement includes advice to continue vaccinating against COVID-19, as people who are fully vaccinated are far less likely to suffer cardiac complications or long COVID, even if they develop a COVID infection.

They also set out how to diagnose and treat the symptoms brought on by COVID, such as shortness of breath, chest pain and fainting. In particular, the paper recommends structured cardiac rehabilitation programs, including specialized physiotherapy, to prevent longer-term problems from developing following infection and to aid recovery from long COVID.

Professor Vassiliou said, "COVID doesn't only affect the lungs. It can also damage the heart and blood vessels, both during the acute infection and for months afterward. 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."

Finally, the experts call for equal access to cardiac rehabilitation programs, especially for people living in rural locations. Professor Vassiliou explained, "At present, the capacity of rehabilitation services across much of Europe is insufficient to accommodate both conventional cardiac patients and those with cardiac long COVID.

"There are also significant regional variations. Targeted financial investment and resource allocation are therefore required to expand service capacity and ensure equitable access.

"Unfortunately, even now, cardiac long COVID continues to affect the quality of life for many patients. We need to ensure patients have equitable access to rehabilitation services, support primary prevention through vaccination and lifestyle programs, and fund research into long COVID and cardiovascular outcomes. Health systems must be prepared for the ongoing burden, not just the acute infection."