Long-term cardiovascular impact of COVID-19 among hospitalised and non-hospitalised populations: a narrative synthesis review

Introduction – COVID-19, initially recognised as a respiratory illness, affects multiple organ systems, including the cardiovascular system. Both hospitalised and non-hospitalised patients may experience persistent cardiac complications; however, the long-term impact across different levels of disease severity remains unclear. This review aims to summarise the existing evidence on the long-term cardiovascular impact of COVID-19, with a particular focus on differences between hospitalised and non-hospitalised patients. Method – PubMed, MEDLINE, CINAHL, and Embase databases were searched for studies published between December 2019 and January 2024 that investigated cardiovascular outcomes in long COVID. Studies were screened for eligibility, and data were extracted using a standardised form. Due to heterogeneity across the included studies, a narrative synthesis was performed. Results – Seventy-one studies were included, most of which were observational and conducted in Europe and Asia, with follow-up periods ranging from <1 to >24 months. Hospitalised patients reported more frequent cardiovascular symptoms; however, echocardiographic abnormalities were observed across all groups. Reporting of symptom severity was inconsistent. Common cardiovascular manifestations included palpitations, chest pain, fatigue, and arrhythmias. Persistent cardiac dysfunction and dysautonomia were observed regardless of hospitalisation status. Conclusion – Hospitalised patients are at higher risk of long-term cardiovascular complications, including myocardial injury, arrhythmias, and heart failure, while non-hospitalised individuals may experience subclinical cardiac changes. Vaccination appears to have a protective effect. Standardised, prospective studies are needed to clarify long-term cardiovascular risks and to guide follow-up care.