Cardiovascular post-acute sequelae of SARS-CoV-2 in children and adolescents: cohort study using electronic health records

Bingyu Zhang; Deepika Thacker; Ting Zhou; Dazheng Zhang; Yuqing Lei; Jiajie Chen; Elizabeth A Chrischilles; Dimitri A Christakis; Soledad Fernandez; Vidu Garg; Susan Kim; Abu S M Mosa; Marion R Sills; Bradley W Taylor; David A Williams; Qiong Wu; Christopher B Forrest; Yong Chen

doi:10.1038/s41467-025-56284-0

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Cardiovascular post-acute sequelae of SARS-CoV-2 in children and adolescents: cohort study using electronic health records

Journal article

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Cardiovascular post-acute sequelae of SARS-CoV-2 in children and adolescents: cohort study using electronic health records

Bingyu Zhang, Deepika Thacker, Ting Zhou, Dazheng Zhang, Yuqing Lei, Jiajie Chen, Elizabeth A Chrischilles, Dimitri A Christakis, Soledad Fernandez, Vidu Garg, …

Nature communications, Vol.16(1), 3445

04/11/2025

DOI: 10.1038/s41467-025-56284-0

PMCID: PMC11992182

PMID: 40216777

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Abstract

The risk of cardiovascular outcomes following SARS-CoV-2 infection has been reported in adults, but evidence in children and adolescents is limited. This paper assessed the risk of a multitude of cardiac signs, symptoms, and conditions 28-179 days after infection, with outcomes stratified by the presence of congenital heart defects (CHDs), using electronic health records (EHR) data from 19 children's hospitals and health institutions from the United States within the RECOVER consortium between March 2020 and September 2023. The cohort included 297,920 SARS-CoV-2-positive individuals and 915,402 SARS-CoV-2-negative controls. Every individual had at least a six-month follow-up after cohort entry. Here we show that children and adolescents with prior SARS-CoV-2 infection are at a statistically significant increased risk of various cardiovascular outcomes, including hypertension, ventricular arrhythmias, myocarditis, heart failure, cardiomyopathy, cardiac arrest, thromboembolism, chest pain, and palpitations, compared to uninfected controls. These findings were consistent among patients with and without CHDs. Awareness of the heightened risk of cardiovascular disorders after SARS-CoV-2 infection can lead to timely referrals, diagnostic evaluations, and management to mitigate long-term cardiovascular complications in children and adolescents.

Electronic Health Records

Adolescent

Cardiovascular Diseases - epidemiology

Cardiovascular Diseases - etiology

Child

Child, Preschool

Cohort Studies

COVID-19 - complications

COVID-19 - epidemiology

COVID-19 - virology

Female

Heart Defects, Congenital - complications

Heart Defects, Congenital - epidemiology

Humans

Infant

Male

Risk Factors

SARS-CoV-2

United States - epidemiology

Details

Title: Subtitle: Cardiovascular post-acute sequelae of SARS-CoV-2 in children and adolescents: cohort study using electronic health records
Creators: Bingyu Zhang - University of Pennsylvania
Deepika Thacker - Nemours Children's Health System
Ting Zhou - University of Pennsylvania
Dazheng Zhang - University of Pennsylvania
Yuqing Lei - University of Pennsylvania
Jiajie Chen - University of Pennsylvania
Elizabeth A Chrischilles - University of Iowa
Dimitri A Christakis - Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
Soledad Fernandez - The Ohio State University
Vidu Garg - The Ohio State University
Susan Kim - University of California, San Francisco
Abu S M Mosa - University of Missouri
Marion R Sills - Children's Hospital Colorado
Bradley W Taylor - Medical College of Wisconsin
David A Williams - University of Michigan
Qiong Wu - University of Pittsburgh
Christopher B Forrest - Children's Hospital of Philadelphia
Yong Chen - University of Pennsylvania
Resource Type: Journal article
Publication Details: Nature communications, Vol.16(1), 3445
DOI: 10.1038/s41467-025-56284-0
PMID: 40216777
PMCID: PMC11992182
NLM abbreviation: Nat Commun
ISSN: 2041-1723
eISSN: 2041-1723
Publisher: NATURE PORTFOLIO
Grant note: OT2HL161847-01 / U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI)
Language: English
Date published: 04/11/2025
Academic Unit: Pharmacy; Epidemiology
Record Identifier: 9984808277402771

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