Relationship Between COVID-19 and Cardiovascular Disease in Critically Ill Patients: A Systematic Review of the Literature

Cardiovascular complications are frequently reported in patients with severe COVID-19; however, their spectrum and clinical relevance in critically ill patients have not been fully characterized. To systematically review the literature to identify the main cardiovascular complications occurring in patients with severe COVID-19 admitted to intensive care units (ICUs). A systematic search of three electronic databases was conducted from December 2019 to January 1, 2025. Observational studies including adult patients with severe COVID-19 admitted to ICUs and reporting cardiovascular complications were eligible, without language restrictions. Study selection and qualitative synthesis were performed according to predefined criteria. The primary outcomes were pre-existing cardiovascular comorbidities and cardiovascular complications occurring during ICU stay. Eight observational cohort studies met the inclusion criteria. A high prevalence of baseline cardiovascular comorbidities was consistently reported, particularly arterial hypertension, obesity, smoking history, and diabetes mellitus. The most frequently described cardiovascular complications in critically ill patients included circulatory failure, thromboembolic events, myocardial injury, cardiac arrhythmias, and cerebrovascular events. The reported frequency of these complications varied across studies. Cardiovascular complications are common among critically ill patients with COVID-19, with circulatory failure and thromboembolic and arrhythmic events being the most consistently reported. These findings highlight the need for early cardiovascular monitoring and multidisciplinary management in this population.