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Published on: July 18, 2014
COVID-19 in Adults With Congenital Heart Disease
Craig S Broberg1, Adrienne H Kovacs1, Soraya Sadeghi2
1Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
Insights
COVID-19 outcomes in adults with congenital heart disease (CHD) were studied. Mortality was similar to the general population, with physiological stage, not complexity, predicting severity in these patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Adults with congenital heart disease (CHD) were considered at high risk for severe outcomes from novel coronavirus disease-19 (COVID-19).
- Understanding the specific impact and risk factors for COVID-19 in this population is crucial.
Purpose of the Study:
- To define the impact of COVID-19 on adults with CHD.
- To identify risk factors associated with adverse outcomes, including death or severe infection.
Main Methods:
- A global cohort study included 1,044 adults (≥18 years) with confirmed or suspected COVID-19 from 58 adult CHD centers.
- Data collected included diagnosis, interventions, comorbidities, medications, symptoms, illness course, and outcomes.
- Statistical analysis identified predictors of death or severe infection.
Main Results:
- The cohort included patients with various CHD types, including single ventricle physiology, cyanosis, and pulmonary hypertension.
- There were 24 COVID-related deaths, representing a case fatality rate of 2.3%.
- Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and prior heart failure hospitalization. Worse physiological stage predicted mortality, while anatomic complexity did not.
Conclusions:
- COVID-19 mortality in adults with CHD is comparable to the general population.
- Patients with poorer physiological status, such as cyanosis and pulmonary hypertension, are most vulnerable.
- Anatomic complexity of CHD does not appear to predict the severity of COVID-19 infection.
Background:
Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications.
Objectives:
This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes.
Methods:
Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined.
Results:
From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not.
Conclusions:
COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.
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