Epidemiology of myocarditis following COVID-19 or influenza and use of diagnostic assessments
Background Previous research has suggested a heightened risk of acute myocarditis after COVID-19 infection. However, it is not clear from existing work whether this risk is higher than would be expected after comparable viral respiratory infections. This information is important to guide risk assess...
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BMJ Publishing Group
2024-11-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/11/2/e002947.full |
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| author | Jeanette Schulz-Menger Alexander Michel Sebastian Kelle Yuchi Han Zahra Raisi-Estabragh Jiwon Kim Oisin Butler Ann Kathrin Frenz Cornelia Harz |
| author_facet | Jeanette Schulz-Menger Alexander Michel Sebastian Kelle Yuchi Han Zahra Raisi-Estabragh Jiwon Kim Oisin Butler Ann Kathrin Frenz Cornelia Harz |
| author_sort | Jeanette Schulz-Menger |
| collection | DOAJ |
| description | Background Previous research has suggested a heightened risk of acute myocarditis after COVID-19 infection. However, it is not clear from existing work whether this risk is higher than would be expected after comparable viral respiratory infections. This information is important to guide risk assessments and clinical practice.Methods A retrospective cohort study of US administrative health claims was conducted to compare the rates of myocarditis after COVID-19 with that after influenza infection and describe the clinical use of diagnostic assessments.Patients with either incident COVID-19 diagnosis (between 1 January 2020 and 31 December 2021) or incident influenza diagnosis (between 1 January 2016 and 31 December 2018), with at least 12 months of continuous enrolment prior to index date and without a previous diagnosis of myocarditis were included.The primary outcome was clinically diagnosed acute myocarditis recorded after COVID-19 or influenza infection. Results are reported as covariate-adjusted subdistribution HRs from competing risk regression with COVID-19 considered as the exposure of interest and influenza as the reference group. Death was considered a competing risk.Results 1 120 760 adult COVID-19 patients and 439 278 adult influenza patients were identified, of which 669 (0.06%) adult COVID-19 patients and 91 (0.02%) adult influenza patients received a diagnosis of myocarditis. The myocarditis rate per 1000 person-years was 0.73 (95% CI 0.67 to 0.78) for adult COVID-19 patients and 0.24 (95% CI 0.19 to 0.28) for adult influenza populations. In models comprehensively adjusted for demographic and clinical risk factors, COVID-19 diagnosis (compared with influenza diagnosis), cardiac comorbidities, being male and under the age of 30 were independently associated with an increased risk of myocarditis in the year after diagnosis.Conclusions These findings support a distinct link between COVID-19 and myocarditis, which appears greater than after a similar viral respiratory infection. As such, a greater degree of clinical suspicion and investigation according to existing diagnostic pathways is recommended. |
| format | Article |
| id | doaj-art-0e11dfb792ae4ab399ec9fa91c2dfaee |
| institution | OA Journals |
| issn | 2053-3624 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-0e11dfb792ae4ab399ec9fa91c2dfaee2025-08-20T02:14:54ZengBMJ Publishing GroupOpen Heart2053-36242024-11-0111210.1136/openhrt-2024-002947Epidemiology of myocarditis following COVID-19 or influenza and use of diagnostic assessmentsJeanette Schulz-Menger0Alexander Michel1Sebastian Kelle2Yuchi Han3Zahra Raisi-Estabragh4Jiwon Kim5Oisin Butler6Ann Kathrin Frenz7Cornelia Harz8Experimental and Clinical Research Center (ECRC), a cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany2 Epidemiology, Bayer Basel, Basel, SwitzerlandDepartment of Internal Medicine/Cardiology, Deutsches Herzzentrum, Berlin, GermanyCardiovascular Division, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA4 Saint Bartholomew`s Hospital Barts Heart Centre, London, UKWeill Cornell Medicine, New York, New York, USARadiology Medical Affairs, Bayer AG, Berlin, GermanyMedical Affairs Statistics, Bayer AG, Leverkusen, GermanyRadiology Medical Affairs, Bayer AG, Berlin, GermanyBackground Previous research has suggested a heightened risk of acute myocarditis after COVID-19 infection. However, it is not clear from existing work whether this risk is higher than would be expected after comparable viral respiratory infections. This information is important to guide risk assessments and clinical practice.Methods A retrospective cohort study of US administrative health claims was conducted to compare the rates of myocarditis after COVID-19 with that after influenza infection and describe the clinical use of diagnostic assessments.Patients with either incident COVID-19 diagnosis (between 1 January 2020 and 31 December 2021) or incident influenza diagnosis (between 1 January 2016 and 31 December 2018), with at least 12 months of continuous enrolment prior to index date and without a previous diagnosis of myocarditis were included.The primary outcome was clinically diagnosed acute myocarditis recorded after COVID-19 or influenza infection. Results are reported as covariate-adjusted subdistribution HRs from competing risk regression with COVID-19 considered as the exposure of interest and influenza as the reference group. Death was considered a competing risk.Results 1 120 760 adult COVID-19 patients and 439 278 adult influenza patients were identified, of which 669 (0.06%) adult COVID-19 patients and 91 (0.02%) adult influenza patients received a diagnosis of myocarditis. The myocarditis rate per 1000 person-years was 0.73 (95% CI 0.67 to 0.78) for adult COVID-19 patients and 0.24 (95% CI 0.19 to 0.28) for adult influenza populations. In models comprehensively adjusted for demographic and clinical risk factors, COVID-19 diagnosis (compared with influenza diagnosis), cardiac comorbidities, being male and under the age of 30 were independently associated with an increased risk of myocarditis in the year after diagnosis.Conclusions These findings support a distinct link between COVID-19 and myocarditis, which appears greater than after a similar viral respiratory infection. As such, a greater degree of clinical suspicion and investigation according to existing diagnostic pathways is recommended.https://openheart.bmj.com/content/11/2/e002947.full |
| spellingShingle | Jeanette Schulz-Menger Alexander Michel Sebastian Kelle Yuchi Han Zahra Raisi-Estabragh Jiwon Kim Oisin Butler Ann Kathrin Frenz Cornelia Harz Epidemiology of myocarditis following COVID-19 or influenza and use of diagnostic assessments Open Heart |
| title | Epidemiology of myocarditis following COVID-19 or influenza and use of diagnostic assessments |
| title_full | Epidemiology of myocarditis following COVID-19 or influenza and use of diagnostic assessments |
| title_fullStr | Epidemiology of myocarditis following COVID-19 or influenza and use of diagnostic assessments |
| title_full_unstemmed | Epidemiology of myocarditis following COVID-19 or influenza and use of diagnostic assessments |
| title_short | Epidemiology of myocarditis following COVID-19 or influenza and use of diagnostic assessments |
| title_sort | epidemiology of myocarditis following covid 19 or influenza and use of diagnostic assessments |
| url | https://openheart.bmj.com/content/11/2/e002947.full |
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