Clinical risk associated with COVID-19 among 86000 patients with congenital heart disease
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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Simon G Williams1, Simon Frain1, Hui Guo2
1Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Insights
Patients with congenital heart disease (CHD) face a 50-75% higher risk of hospitalization and death from COVID-19. This risk increases with the physiological severity of their heart condition. Further research is needed to understand these outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Congenital heart disease (CHD) affects cardiovascular structure and function from birth.
- The COVID-19 pandemic posed significant risks to vulnerable populations, including those with underlying health conditions.
Purpose of the Study:
- To quantify the excess risk of COVID-19 hospitalization and mortality in patients with CHD within the UK.
- To investigate how CHD severity influences COVID-19 outcomes.
Main Methods:
- A matched case-control study utilizing anonymized general practice records from the UK's National Health Service.
- Patients with CHD were stratified by disease severity using European Society of Cardiology guidelines.
- Comparison of COVID-19 positive cases, hospitalizations, and mortality between CHD patients and matched controls.
Main Results:
- The study included 86,441 patients with CHD and 335,839 controls.
- Patients with CHD were significantly more likely to be hospitalized (OR=1.77) and die (OR=1.60) from COVID-19 compared to controls.
- Increased physiological severity of CHD, such as pulmonary vascular disease or cyanosis, correlated with higher excess risk.
Conclusions:
- Patients with CHD experienced a 50-75% higher risk of hospitalization and mortality following COVID-19 infection.
- These findings represent the first primary care-derived estimates for COVID-19 outcomes in CHD patients.
- Factors like non-white ethnicity and comorbidities such as pulmonary hypertension influenced COVID-19 outcomes in this cohort.
Objective:
To determine the magnitude of any excess risk of mortality and hospitalisation due to COVID-19 infection in patients with congenital heart disease (CHD) in the UK healthcare system.
Methods:
Matched case-control study within the Clinical Practice Research Datalink study of anonymised general practice records in the National Health Service in England. Patients with CHD were stratified for disease severity according to the European Society of Cardiology guidelines. Presence of a positive COVID-19 test, hospitalisation with a diagnosis of COVID-19 and COVID-19-related mortality were compared in case and control groups.
Results:
86 441 patients with CHD and 335 839 controls were studied. Of patients with a positive COVID-19 test, patients with CHD were more likely than controls to be hospitalised (22.4% vs 14.5%; OR=1.77 (95% CI 1.60 to 1.96); p=2.11e-28) and suffer COVID-19-related death (6.1% vs 3.8%; OR=1.60 (95% CI 1.35 to 1.89); p=7.00e-08). The excess risk of COVID-19 hospitalisation and death rose with increasing physiological severity of CHD (presence of pulmonary vascular disease and/or cyanosis), rather than anatomical complexity.
Conclusions:
In this study of the COVID-19 pandemic experience, using population health records in over 86000 patients with CHD in England, patients with CHD with COVID-19 were at around 50-75% higher risk of hospitalisation and mortality compared with matched controls with COVID-19. We provide the first primary care-derived estimates for COVID-19 hospitalisation and case-fatality rates in patients with CHD. Some factors predictive of worse COVID-19 outcome in general populations (such as non-white ethnic group), and other CHD-specific comorbidities (such as pulmonary hypertension), influenced outcomes among patients with CHD.
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