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 () and Yong Chen ()
Additional contact information
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: The University of Iowa
Dimitri A. Christakis: Seattle Children’s Research Institute
Soledad Fernandez: Ohio State University
Vidu Garg: Nationwide Children’s Hospital
Susan Kim: University of California San Francisco
Abu S. M. Mosa: University of Missouri School of Medicine
Marion R. Sills: Inc
Bradley W. Taylor: Medical College of Wisconsin
David A. Williams: University of Michigan
Qiong Wu: University of Pennsylvania
Christopher B. Forrest: Children’s Hospital of Philadelphia
Yong Chen: University of Pennsylvania

Nature Communications, 2025, vol. 16, issue 1, 1-12

Abstract: 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.

Date: 2025
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DOI: 10.1038/s41467-025-56284-0

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