Complications of SARS-CoV-2 Infection During Cardiac Rehabilitation: A Case Series

Martina Zappa; Paolo Verdecchia; Andrea Andolina; Antonio Spanevello; Fabio Angeli

doi:10.1007/s40119-023-00325-6

Complications of SARS-CoV-2 Infection During Cardiac Rehabilitation: A Case Series

Cardiol Ther. 2023 Sep;12(3):533-538. doi: 10.1007/s40119-023-00325-6. Epub 2023 Jul 15.

Authors

Martina Zappa¹, Paolo Verdecchia², Andrea Andolina³, Antonio Spanevello^{3

1}, Fabio Angeli^{4

5}

Affiliations

¹ Department of Medicine and Surgery, University of Insubria, Varese, Italy.
² Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy.
³ Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Via Crotto Roncaccio 16, Tradate, VA, Italy.
⁴ Department of Medicine and Technological Innovation (DiMIT), University of Insubria, Varese, Italy. fabio.angeli@uninsubria.it.
⁵ Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Via Crotto Roncaccio 16, Tradate, VA, Italy. fabio.angeli@uninsubria.it.

Abstract

Introduction: Vaccination strongly reduces the risk of hospitalization and death due to coronavirus disease 2019 (COVID-19). However, the severity of the acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and the degree of protection exerted over time by vaccination remains to be fully elucidated among hospitalized comorbid and vulnerable patients with SARS-CoV-2 infection.

Methods: We report a case series of nine hospitalized vulnerable patients who developed a SARS-CoV-2 infection during a cardiac rehabilitation inpatient program.

Results: Age ranged from 50 to 81 years. All but one patient had received at least three doses of anti-COVID-19 vaccine more than 4 months before the cardiac event. Indications for cardiac rehabilitation included acute coronary syndromes, congestive heart failure, heart valve surgery, and coronary artery bypass graft. After the confirmed diagnosis of SARS-CoV-2 infection, all patients developed symptoms. Eight patients developed at least one SARS-CoV-2-related complication, including a significant increase in high-sensitivity troponin I levels, new-onset hypoxemia, persistent atrial fibrillation, non-sustained ventricular tachycardia and recurrent sinus arrest, pericardial effusion, and a persistent increase in blood pressure.

Conclusion: Almost all patients developed complications which, however, did not evolve towards more severe expressions of the disease. These data suggest that even in this new phase of the pandemic, vaccination may exert a potential role to reduce the risk of progression towards more severe disease of SARS-CoV-2 infection in vulnerable patients with cardiovascular comorbidities.

Keywords: Acute respiratory syndrome coronavirus-2 (SARS-CoV-2); Cardiac rehabilitation; Complications; Coronavirus disease 2019 (COVID-19); Therapy; Vaccination.