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Grand Rounds

CDC Reports: The Latest on COVID-19 and Increased Risk of Myocarditis

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BACKGROUND AND PURPOSE:

  • SARS-CoV-2 infection appears to be associated with increased risk of myocarditis
  • In this CDC Weekly Report, Boehmer et al. (MMWR, 2021) assess the relationship between myocarditis and SARS-CoV-2 infection using a large, US-based database

METHODS:

  • Patient-level cohort study
    • Premier Healthcare Database Special COVID-19 Release (Large hospital-based administrative database)
  • Population
    • All patients in with ≥1 inpatient or hospital-based outpatient encounter
    • Discharge between March 2020 to January 2021
    • Exclusion: Vaccinated individuals
  • Exposures
    • SARS-CoV-2 infection
  • Study design
    • Risk of myocarditis was calculated overall and by subgroup (sex and age group)
  • Primary outcome
    • Myocarditis encounters occurring during or after SARS-CoV-2 infection

RESULTS:

  • 36,005,294 patients
    • COVID-19 diagnoses: 4% (1,452,773 patients)
    • Myocarditis diagnoses
      • With COVID-19: 0.146%
      • Without COVID-19: 0.009%
    • Overall myocarditis diagnoses with history of COVID-19: 41.7%
  • In adjusted analyses, COVID-19 was significantly associated with increased risk for myocarditis
    • Adjusted risk ratio (RR) 15.7 (95% CI, 14.1 to 17.2)
  • Adjusted myocarditis risk difference (RD) was small due to small number of myocarditis cases
    • aRD 0.126% (95% CI, 0.112 to 0.140)
  • The adjusted risk of myocarditis was higher among males
    • Males: aRR 0.165% (95% CI, 0.146 to 0.183)
    • Females: aRR 0.100% (95% CI, 0.087 to 0.113)
  • The risk of myocarditis was lowest for patients aged 25 to 39 years, and risk was higher among younger and older ages groups
    • Patients aged 16 to 24 and 25 to 39 years: aRR 7.0
    • Patients aged <16 years and ≥75 years: aRR >30.0

CONCLUSION:

  • Risk was higher in males than in females
    • Risk varied by age group, with the youngest and oldest patients having the highest associated risk
  • The results of this study corroborate a recent study from Israel that found that while mRNA COVID-19 vaccination is associated with an elevated risk for myocarditis (risk ratio = 3.24; 95% CI = 1.55–12.44), SARS-CoV-2 infection is a strong risk factor for myocarditis (risk ratio = 18.28, 95% CI = 3.95–25.12)
  • The authors state

Myocarditis is uncommon among patients with and without COVID-19; however, COVID-19 is a strong and significant risk factor for myocarditis, with risk varying by age group

The findings in this report underscore the importance of implementing evidence-based COVID-19 prevention strategies, including vaccination, to reduce the public health impact of COVID-19 and its associated complications

Learn More – Primary Sources:

Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021

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Related ObG Topics:

CDC Reports on the Risk of Myocarditis with COVID-19 Vaccination
Is Blood Viscosity Greater in Patients with Severe COVID-19?
COVID-19: What are the Potential Long-Term Cardiovascular Consequences?

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