Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021
Open accessAbstract
Viral infections are a common cause of myocarditis, an inflammation of the heart muscle (myocardium) that can result in hospitalization, heart failure, and sudden death (1). Emerging data suggest an association between COVID-19 and myocarditis (2-5). CDC assessed this association using a large, U.S. hospital-based administrative database of health care encounters from >900 hospitals. Myocarditis inpatient encounters were 42.3% higher in 2020 than in 2019. During March 2020-January 2021, the period that coincided with the COVID-19 pandemic, the risk for myocarditis was 0.146% among patients diagnosed with COVID-19 during an inpatient or hospital-based outpatient encounter and 0.009% among patients who were not diagnosed with COVID-19. After adjusting for patient and hospital characteristics, patients with COVID-19 during March 2020-January 2021 had, on average, 15.7 times the risk for myocarditis compared with those without COVID-19 (95% confidence interval [CI] = 14.1-17.2); by age, risk ratios ranged from approximately 7.0 for patients aged 16-39 years to >30.0 for patients aged <16 years or ≥75 years. Overall, myocarditis was uncommon among persons with and without COVID-19; however, COVID-19 was significantly associated with an increased risk for myocarditis, with risk varying by age group. These findings underscore the importance of implementing evidence-based COVID-19 prevention strategies, including vaccination, to reduce the public health impact of COVID-19 and its associated complications.
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COVID-19-associated myocarditis incidence ranged from 150 to 4000 cases per 100,000 individuals.
“with COVID ranging from 150 to 4000 cases/100 000 individuals”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [85]
The paper’s overall results report a 0.146% myocarditis risk among hospital-encounter patients diagnosed with COVID-19, approximately 146 per 100,000 and close to the claimed lower bound. They do not support a range reaching 4,000 per 100,000; the reported 4.0% figure is the proportion of the cohort diagnosed with COVID-19, not the myocarditis risk. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe overall incidence of myocarditis in the United States from SARS-CoV-2 infection has been estimated by the Centers for Disease Control and Prevention at around 150 cases per 100,000 versus 9 cases per 100,000 individuals in non-COVID cases during the same time period.
“The overall incidence of myocarditis in the United States from SARSCoV-2 infection has been estimated in a study by the Centers for Disease Control and Prevention at around 150 cases/100 000 versus 9 cases/100 000 individuals in non-COVID cases during the same time period (Table 1).”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [85]
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Effects of COVID-19 on Arrhythmia
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Vaccines against Group B Coxsackieviruses and Their Importance
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COVID-19 and its long-term impact on the cardiovascular system
Philip, B., Mukherjee, P., Khare, Y., Ramesh, P., Zaidi, S., Sabry, H., & Harky, A. (2023) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2023.2184800 · Cited by 19 · see citing works
COVID-19-Induced Myocarditis: Pathophysiological Roles of ACE2 and Toll-like Receptors
Pannucci, P., Jefferson, S. R., Hampshire, J., Cooper, S. L., Hill, S. J., & Woolard, J. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24065374 · Cited by 20 · see citing works
Ishisaka, Y., Watanabe, A., Aikawa, T., Kanaoka, K., Takagi, H., Wiley, J., Yasuhara, J., & Kuno, T. (2023) · International Journal of Cardiology · doi:10.1016/j.ijcard.2023.131401 · Cited by 19 · see citing works
van den Ouweland, F., Charpentier, N., Türeci, Ö., Rizzi, R., Mensa, F., Lindemann, C., & Pather, S. (2024) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2024.2315659 · Cited by 20 · see citing works
Long COVID-19 Myocarditis and Various Heart Failure Presentations: A Case Series
Rohun, J., Dorniak, K., Faran, A., Kochańska, A., Zacharek, D., & Daniłowicz‐Szymanowicz, L. (2022) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd9120427 · Cited by 19 · see citing works
Yugar‐Toledo, J. C., Yugar, L. B. T., Sedenho‐Prado, L. G., Schreiber, R., & Moreno, H. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1162837 · Cited by 18 · see citing works
COVID-19-Associated Myocarditis: An Evolving Concern in Cardiology and Beyond
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Li, J., Fan, H., Yang, Y., Huang, Z., Yuan, Y., & Liang, B. (2024) · BMC Cardiovascular Disorders · doi:10.1186/s12872-024-04402-z · Cited by 17 · see citing works
Long-term cardiac surveillance and outcomes of COVID-19 patients
Mitrani, R. D., Dabas, N., Alfadhli, J., Lowery, M. H., Best, T. M., Hare, J. M., Myerburg, R. J., & Goldberger, J. J. (2022) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2022.06.003 · Cited by 17 · see citing works
Urdaneta, V., Esposito, D. B., Dharia, P., Moraga, M. S., Anteyi, K., Oduyebo-Omotosho, T., Rossi, M., Burton, P. R., Vega, J. M., Dawson, R. S., et al. (2024) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofae067 · Cited by 16 · see citing works
The Cardiovascular Manifestations of COVID-19
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Severe Acute Respiratory Syndrome Coronavirus 2 Infections in Children
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Buitrago, D., Munoz, J., Finkelstein, E. R., & Mulinari, L. (2022) · Journal of Cardiac Surgery · doi:10.1111/jocs.16313 · Cited by 15 · see citing works
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McKinnon, J. E., Wang, D. D., Zervos, M., Saval, M., Marshall-Nightengale, L., Kilgore, P. E., Pabla, P., Szandzik, E. G., Maksimowicz‐McKinnon, K., & O’Neill, W. W. (2021) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2021.12.343 · Cited by 14 · see citing works
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Case Report: Myocarditis After COVID-19 Vaccination – Case Series and Literature Review
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Advanced cardiac imaging in the spectrum of COVID-19 related cardiovascular involvement
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COVID-19 and myocarditis: a brief review
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mRNA-based COVID-19 Vaccines Booster Dose: Benefits, Risks and Coverage.
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Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology
Hamedi, K. R., Loftus, G., Traylor, L. B., Goodwin, R. L., & Arce, S. (2023) · Vaccines · doi:10.3390/vaccines11020362 · Cited by 13 · see citing works
- Authors
- Boehmer, T. K., Kompaniyets, L., Lavery, A. M., Hsu, J., Ko, J. Y., Yusuf, H., Romano, S. D., Gundlapalli, A. V., Oster, M. E., & Harris, A. M.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Boehmer, Tegan K.
- ORCID
- Venue
- MMWR. Morbidity and Mortality Weekly Report
- Published
- 2021-09-03
- Volume
- 70
- Issue
- 35
- Pages
- 1228-1232
- ISSN
- 0149-2195 (ISSN-L)
- 1545-861X
- PMC
- PMC8422872
- OpenAlex
- W3197576044
- Cited by
- 310
- References
- 11
- Citations by year
- 2026: 20 · 2025: 35 · 2024: 56 · 2023: 76 · 2022: 104 · 2021: 19
- FWCI
- 42.74
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- MMWR Morbidity and Mortality Weekly Report (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Surgery › Kawasaki Disease and Coronary Complications
- Keywords
- COVID-19 pandemic, myocarditis, SARS-CoV-2, hospitalization, COVID-19 prevention, COVID-19 vaccination
- MeSH terms
- COVID-19, Adolescent, Adult, Aged, Female, Humans, Male, Medical Records, Middle Aged, Myocarditis, Risk Factors, United States, Databases, Factual, Risk Assessment, Young Adult
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