Better prepared for a future pandemic: more clarity needed about heart damage after COVID-19

How often does heart damage occur during a COVID-19 infection? Are symptoms such as chest pain after COVID-19 a sign of heart damage? ‘These are the questions that we want to answer within the DEFENCE project’, says project leader Marijke Linschoten at Amsterdam UMC. Due to the intensive national collaboration we can access an extensive amount of data. The study aims to provide more insight into the development and consequences of heart damage after COVID-19.

However, much remains unclear about heart damage that people can incur due to a COVID-19 infection. Fortunately, COVID-19 patients admitted to hospital are rarely diagnosed with damage to the heart muscle. But how often does heart damage arise without anyone noticing? And do these people also have a higher risk of developing heart problems in the long term? Marijke Linschoten, project leader within the DEFENCE project, shares her experiences with this blog.

Sensational news

Right at the start of the COVID-19 pandemic, news already emerged that the coronavirus could cause heart muscle inflammation. As a result of this inflammation, heart damage occurs. Even young and healthy people were admitted to hospital with such a heart muscle inflammation. Sensational media headlines about the subject understandably caused anxiety. At that time, hospitals could offer very few insights. That is why the programme of the Netherlands Federation of Medical Specialists at an early stage discerned a knowledge gap concerning heart damage after COVID-19.

Collaborating for extensive data

From the first wave onwards, we began to collect data on a large scale. Due to the collaboration of 45 hospitals in the Netherlands, we have collected research data from more than 40% of all patients who were admitted to hospital during the first wave. To detect heart damage, we also performed additional tests on people who were admitted to hospital during later waves. Finally, within the project group, we examined how often heart damage arose in less ill people, who also had fewer symptoms and recovered at home, including professional sportspeople.

Insight into the long-term consequences

We have now also started to ask people infected during the first wave about their health by means of questionnaires. Afterwards, we invite these respondents to undergo extra tests to establish whether there are heart abnormalities. With this research, we want to unravel whether certain symptoms, such as cardiac arrhythmias and chest pain, in the period after a COVID-19 infection are related to heart damage. By linking the research data collected within DEFENCE to data available at Statistics Netherlands, we can follow patients for a longer period of time and measure the long-term effects. We hope to have completed the first analyses at the end of 2023.

By linking the research data collected within DEFENCE to data available at Statistics Netherlands, we can follow patients for a longer period of time and measure the long-term effects
Marijke Linschoten
PhD Candidate - Department of Cardiology


The project has to contend with the challenge of privacy legislation. Many people mainly think in terms of barriers when it comes to the sharing of data, whereas privacy legislation does render it possible to share data for scientific purposes under certain conditions. It may take some time before you find the right way to do this, which requires people who understand both privacy legislation and scientific research. Unfortunately, a less specialised lawyer can all too easily advise against the sharing of data.

Quick assessment and funding of projects

Due to the urgency of our research, the ZonMw assessment trajectory only took a few months. That was vital to facilitate a quick start. But, besides a quick start, we also aim to complete this research as well as possible. Although 3.5 years have passed since the first wave, we should not allow attention for this subject to slacken. In addition, as a society, we must draw lessons from the experiences of this pandemic: how can we ensure that we are better prepared and have the necessary infrastructure so that we can quickly collect a lot of data for research at the national level in a coordinated manner? In the event of a future pandemic, we need to ensure that so much uncertainty does not exist for so long about an issue as serious as heart damage after a virus infection.

Author: Ilse Bos
Photo: private collection Marijke Linschoten