Heart disease was identified as a risk factor for mortality early in the COVID-19 pandemic. It was unknown if this risk would also apply to patients with congenital heart disease (CHD). To assess this risk, researchers conducted an international, multicenter retrospective study on 1044 patients with CHD who had been diagnosed with COVID-19.
Infection was confirmed by PCR testing in 907 (87%) cases, and the remaining 137 cases were diagnosed based on clinical presentation. Researchers aimed to determine which adults with CHD are most vulnerable to COVID-19, and the severity of COVID-19 related complications in this population. Death constituted the primary outcome, and severe infection the secondary outcome. Severe infection encompassed need for intensive care unit (ICU) admission, intubation, acute respiratory distress syndrome, and renal replacement therapy.
Included in the cohort were patients with a broad range of CHD types. Previous arrhythmias had occurred in 362 (34.7%) patients, and 132 (12.6%) had either a pacemaker or defibrillator. Some of the patients had hypertension (161, or 15.4%), and some had diabetes (65, or 6.2%). There were also 19 patients (1.8%) with cirrhosis, and 88 (8.4%) with known genetic syndromes.
Of the 1044 patients in the cohort, 179 (17%) required hospitalization, and among these 67 (6.4%) required ICU care, and 36 (3.4%) were intubated. Among those who were hospitalized, 24 COVID-19 related deaths occurred, yielding a COVID-19 related case fatality rate of 2.3% (95% CI: 1.4% to 3.2%).
Researchers identified ten factors associated with death: male sex, higher body mass index, previous atrial arrhythmia, diabetes, previous heart failure admission, cyanosis, lower resting oxygen saturation, pulmonary artery hypertension, increased subpulmonic ventricular systolic pressure and an estimated glomerular filtration rate of <60 ml/min/m2 before infection. A worse physiological stage of CHD was associated with mortality (p=0.001).
Factors not associated with death were systemic ventricular systolic function, Fontan palliation, systemic hypertension, moderate valve dysfunction, smoking or vaping history, use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers before infection, previous arrhythmias, presence of a pacemaker and/or defibrillator, and race/ethnicity.
The authors concluded that COVID-19 mortality in adults with CHD is proportional with the general population. Vulnerable CHD patients are those with worse physiological stage, including cyanosis and pulmonary hypertension. The anatomic complexity of the CHD did not increase susceptibility to infection with, or mortality from, COVID-19.
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Author: Kelly Schoonderwoerd
Original article: J Am Coll Cardiol. 2021 Apr 6; 77(13): 1644–1655.