Introduction: COVID-19 is associated with multiple cardiovascular disease (CVD) complications, while pre-existing CVD and CVD risk factors increase the risk of severe COVID. The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of CVD complications or risk factor profiles of hospitalized patients have changed over the course of the pandemic. Methods: We analyzed the AHA COVID-19 CVD registry, a national multi-center registry of hospitalized adults with active COVID-19 infection. Data from March 2020 were excluded, and subsequent periods from April 2020 to December 2021 were divided into 3-month epochs. Trends in CVD risk factors and CVD outcomes, including a composite primary outcome of CVD death, cardiogenic shock, new heart failure (HF), stroke, and MI, were evaluated across epochs. Results: 39,961 patients were included. Mean age was 62±18 years during the first epoch and remained consistent through March 2021, after which it decreased and remained stable (55±18 years by the last epoch; p trend <0.001). Patients admitted later in the pandemic were more likely to be obese and less likely to have existing CVD (p trend <0.001 for each). The incidence of the primary outcome (Figure) increased from 7.2% to 9.8% from the first to the last epoch (p trend <0.001). This was driven by an increase in the diagnosis of MI and stroke. Diagnosed pulmonary embolism also rose from 1.9% to 4.7% over the study period (p trend <0.001). There was no consistent trend in the rates of new HF, cardiogenic shock, or CVD mortality, all of which were uncommon, occurring in ≤2% of the overall study population. Conclusions: Despite a shifting risk factor profile towards a younger population with lower rates of established CVD, the incidence of diagnosed CVD complications among patients hospitalized for COVID-19 increased over the course of the pandemic.