IDEAS home Printed from https://ideas.repec.org/a/nat/natcom/v16y2025i1d10.1038_s41467-025-56284-0.html
   My bibliography  Save this article

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

Author

Listed:
  • Bingyu Zhang

    (University of Pennsylvania
    University of Pennsylvania)

  • Deepika Thacker

    (Nemours Children’s Health System)

  • Ting Zhou

    (University of Pennsylvania
    University of Pennsylvania Perelman School of Medicine)

  • Dazheng Zhang

    (University of Pennsylvania
    University of Pennsylvania Perelman School of Medicine)

  • Yuqing Lei

    (University of Pennsylvania
    University of Pennsylvania Perelman School of Medicine)

  • Jiajie Chen

    (University of Pennsylvania
    University of Pennsylvania Perelman School of Medicine)

  • Elizabeth A. Chrischilles

    (The University of Iowa)

  • Dimitri A. Christakis

    (Seattle Children’s Research Institute)

  • Soledad Fernandez

    (Ohio State University)

  • Vidu Garg

    (Nationwide Children’s Hospital
    The Ohio State University)

  • Susan Kim

    (University of California San Francisco)

  • Abu S. M. Mosa

    (University of Missouri School of Medicine)

  • Marion R. Sills

    (Inc
    University of Colorado School of Medicine and Children’s Hospital Colorado)

  • Bradley W. Taylor

    (Medical College of Wisconsin)

  • David A. Williams

    (University of Michigan)

  • Qiong Wu

    (University of Pennsylvania
    University of Pennsylvania Perelman School of Medicine
    University of Pittsburgh)

  • Christopher B. Forrest

    (Children’s Hospital of Philadelphia)

  • Yong Chen

    (University of Pennsylvania
    University of Pennsylvania
    University of Pennsylvania Perelman School of Medicine
    Leonard Davis Institute of Health Economics)

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.

Suggested Citation

  • 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 &, 2025. "Cardiovascular post-acute sequelae of SARS-CoV-2 in children and adolescents: cohort study using electronic health records," Nature Communications, Nature, vol. 16(1), pages 1-12, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-56284-0
    DOI: 10.1038/s41467-025-56284-0
    as

    Download full text from publisher

    File URL: https://www.nature.com/articles/s41467-025-56284-0
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1038/s41467-025-56284-0?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Ziyad Al-Aly & Yan Xie & Benjamin Bowe, 2021. "High-dimensional characterization of post-acute sequelae of COVID-19," Nature, Nature, vol. 594(7862), pages 259-264, June.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Quanhe Yang & Anping Chang & Xin Tong & Sandra L Jackson & Robert K Merritt, 2024. "Long-term cardiovascular disease outcomes in non-hospitalized medicare beneficiaries diagnosed with COVID-19: Population-based matched cohort study," PLOS ONE, Public Library of Science, vol. 19(5), pages 1-25, May.
    2. Figueiredo, Bernardo & Sheahan, Jacob & Luo, Shiqi & Bird, Stephen & Wong Lit Wan, Dawn & Xenos, Sophia & Itsiopoulos, Catherine & Jessup, Rebecca & Zheng, Zhen, 2024. "Journey mapping long COVID: Agency and social support for long-hauling," Social Science & Medicine, Elsevier, vol. 340(C).
    3. Ainur T. Tauekelova & Zhanar Kalila & Akerke Bakhtiyar & Zarina Sautbayeva & Polina Len & Aliya Sailybayeva & Sadyk Khamitov & Nazira Kadroldinova & Natasha S. Barteneva & Makhabbat S. Bekbossynova, 2023. "Association of Lung Fibrotic Changes and Cardiological Dysfunction with Comorbidities in Long COVID-19 Cohort," IJERPH, MDPI, vol. 20(3), pages 1-18, January.
    4. Vanessa Bertuzzi & Michelle Semonella & Gianluca Castelnuovo & Gerhard Andersson & Giada Pietrabissa, 2022. "Synthesizing Stakeholders Perspectives on Online Psychological Interventions to Improve the Mental Health of the Italian Population during the COVID-19 Pandemic: An Online Survey Study," IJERPH, MDPI, vol. 19(12), pages 1-13, June.
    5. Yunhe Wang & Binbin Su & Marta Alcalde-Herraiz & Nicola L. Barclay & Yaohua Tian & Chunxiao Li & Nicholas J. Wareham & Roger Paredes & Junqing Xie & Daniel Prieto-Alhambra, 2024. "Modifiable lifestyle factors and the risk of post-COVID-19 multisystem sequelae, hospitalization, and death," Nature Communications, Nature, vol. 15(1), pages 1-12, December.
    6. Michal Matuszewski & Yurii Reznikov & Michal Pruc & Frank W. Peacock & Alla Navolokina & Raúl Júarez-Vela & Lukasz Jankowski & Zubaid Rafique & Lukasz Szarpak, 2022. "Prognostic Performance of Cystatin C in COVID-19: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 19(21), pages 1-10, November.
    7. Igor Costa de Lima & Daniel Carvalho de Menezes & Juliana Hiromi Emin Uesugi & Cléa Nazaré Carneiro Bichara & Pedro Fernando da Costa Vasconcelos & Juarez Antônio Simões Quaresma & Luiz Fábio Magno Fa, 2023. "Liver Function in Patients with Long-Term Coronavirus Disease 2019 of up to 20 Months: A Cross-Sectional Study," IJERPH, MDPI, vol. 20(7), pages 1-11, March.
    8. Ivan Chun Hang Lam & Ran Zhang & Kenneth Keng Cheung Man & Carlos King Ho Wong & Celine Sze Ling Chui & Francisco Tsz Tsun Lai & Xue Li & Esther Wai Yin Chan & Chak Sing Lau & Ian Chi Kei Wong & Eric , 2024. "Persistence in risk and effect of COVID-19 vaccination on long-term health consequences after SARS-CoV-2 infection," Nature Communications, Nature, vol. 15(1), pages 1-15, December.
    9. Evan Xu & Yan Xie & Ziyad Al-Aly, 2023. "Long-term gastrointestinal outcomes of COVID-19," Nature Communications, Nature, vol. 14(1), pages 1-10, December.
    10. Chengxi Zang & Yongkang Zhang & Jie Xu & Jiang Bian & Dmitry Morozyuk & Edward J. Schenck & Dhruv Khullar & Anna S. Nordvig & Elizabeth A. Shenkman & Russell L. Rothman & Jason P. Block & Kristin Lyma, 2023. "Data-driven analysis to understand long COVID using electronic health records from the RECOVER initiative," Nature Communications, Nature, vol. 14(1), pages 1-14, December.
    11. André Santa Cruz & Ana Mendes-Frias & Marne Azarias-da-Silva & Sónia André & Ana Isabel Oliveira & Olga Pires & Marta Mendes & Bárbara Oliveira & Marta Braga & Joana Rita Lopes & Rui Domingues & Ricar, 2023. "Post-acute sequelae of COVID-19 is characterized by diminished peripheral CD8+β7 integrin+ T cells and anti-SARS-CoV-2 IgA response," Nature Communications, Nature, vol. 14(1), pages 1-14, December.
    12. Fu, Hongqiao & Cheng, Terence C. & Zhan, Jiajia & Xu, Duo & Yip, Winnie, 2024. "Dynamic effects of the COVID-19 pandemic on the demand for telemedicine services: Evidence from China," Journal of Economic Behavior & Organization, Elsevier, vol. 220(C), pages 531-557.
    13. Tianchu Lyu & Nicole Hair & Nicholas Yell & Zhenlong Li & Shan Qiao & Chen Liang & Xiaoming Li, 2021. "Temporal Geospatial Analysis of COVID-19 Pre-Infection Determinants of Risk in South Carolina," IJERPH, MDPI, vol. 18(18), pages 1-18, September.
    14. Rúbens Prince dos Santos Alves & Julia Timis & Robyn Miller & Kristen Valentine & Paolla Beatriz Almeida Pinto & Andrew Gonzalez & Jose Angel Regla-Nava & Erin Maule & Michael N. Nguyen & Norazizah Sh, 2024. "Human coronavirus OC43-elicited CD4+ T cells protect against SARS-CoV-2 in HLA transgenic mice," Nature Communications, Nature, vol. 15(1), pages 1-20, December.
    15. Yan Xie & Benjamin Bowe & Ziyad Al-Aly, 2021. "Burdens of post-acute sequelae of COVID-19 by severity of acute infection, demographics and health status," Nature Communications, Nature, vol. 12(1), pages 1-12, December.
    16. Chengxi Zang & Daniel Guth & Ann M. Bruno & Zhenxing Xu & Haoyang Li & Nariman Ammar & Robert Chew & Nick Guthe & Emily Hadley & Rainu Kaushal & Tanzy Love & Brenda M. McGrath & Rena C. Patel & Elizab, 2025. "Long COVID after SARS-CoV-2 during pregnancy in the United States," Nature Communications, Nature, vol. 16(1), pages 1-14, December.
    17. Stelson, Elisabeth A. & Dash, Devanshi & McCorkell, Lisa & Wilson, Cali & Assaf, Gina & Re'em, Yochai & Wei, Hannah, 2023. "Return-to-work with long COVID: An Episodic Disability and Total Worker Health® analysis," Social Science & Medicine, Elsevier, vol. 338(C).
    18. Carlos M. Pérez-Lara & Doris D. Lara-Malca & Luz A. Baltodano-Nontol & Jessica E. Vicuña-Villacorta & Liliana M. Haro-León & Julio A. Rodríguez-Azabache, 2024. "Advances in Studies on Psychological Symptoms in Patients Surviving Covid-19: A Bibliometric Analysis," Academic Journal of Interdisciplinary Studies, Richtmann Publishing Ltd, vol. 13, January.
    19. Chansavath Phetsouphanh & Brendan Jacka & Sara Ballouz & Katherine J. L. Jackson & Daniel B. Wilson & Bikash Manandhar & Vera Klemm & Hyon-Xhi Tan & Adam Wheatley & Anupriya Aggarwal & Anouschka Akerm, 2024. "Improvement of immune dysregulation in individuals with long COVID at 24-months following SARS-CoV-2 infection," Nature Communications, Nature, vol. 15(1), pages 1-15, December.
    20. Wangzi Xu & Yu Cao & Lin Wu, 2023. "No Causal Effects Detected in COVID-19 and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Two Sample Mendelian Randomization Study," IJERPH, MDPI, vol. 20(3), pages 1-13, January.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-56284-0. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.nature.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.