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The impact of COVID-19 vaccination on patients with congenital heart disease in England: a case-control study
Catriona Harrison1, Simon Frain1, Farideh Jalalinajafabadi1
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
COVID-19 vaccination significantly reduced hospitalization and death rates in patients with congenital heart disease (CHD). However, vaccinated CHD patients still face higher risks than those without CHD, underscoring the need for continued vigilance.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Congenital heart disease (CHD) patients were previously identified as high-risk for severe COVID-19.
- The impact of COVID-19 vaccination on this vulnerable population required evaluation.
Purpose of the Study:
- To assess the effectiveness of COVID-19 vaccination in mitigating severe outcomes among patients with congenital heart disease.
- To compare COVID-19 outcomes in vaccinated and unvaccinated CHD patients against matched controls.
Main Methods:
- A case-control study utilized linked English electronic health records (n=318,135).
- Two cohorts were analyzed: 'prevaccination' (unvaccinated CHD patients and controls, March-December 2020) and 'post-vaccination' (vaccinated CHD patients and controls, March 2021-April 2022).
- Conditional logistic regression compared odds of severe COVID-19 outcomes, also examining vaccine efficacy decline and associated complications.
Main Results:
- Post-vaccination CHD patients showed substantially lower rates of COVID-19 hospitalization (0.5%) and mortality (0.5%) compared to the prevaccination cohort (15.8% and 4.6%, respectively).
- Despite vaccination, CHD patients remained at increased risk of hospitalization (adjusted OR 2.24) and death (adjusted OR 1.81) compared to vaccinated controls.
- No significant differences were observed in the rate of vaccine efficacy decline or incidence of myocarditis, pericarditis, or thrombotic events between CHD patients and controls.
Conclusions:
- COVID-19 vaccination demonstrably lowered the absolute risk of severe outcomes in individuals with congenital heart disease.
- A persistent elevated risk for severe COVID-19 outcomes exists in vaccinated CHD patients compared to vaccinated individuals without CHD.
- These findings highlight the critical importance of vaccination for the CHD population and the need for ongoing vigilance by healthcare providers managing COVID-19 in these patients.
Background:
Studies predating widespread COVID-19 vaccination identified patients with congenital heart disease (CHD) as a group at increased risk of severe outcomes from COVID-19. Here we evaluate the impact of vaccination on COVID-19 outcomes among patients with CHD.
Methods:
We conducted a case-control study using linked English electronic health records (n=3 18 135). Patients with CHD were matched with controls by age, sex, ethnicity and GP practice. The 'prevaccination' cohort comprised unvaccinated patients with CHD and matched controls with first-recorded SARS-CoV-2 infection between 1 March and 8 December 2020 (7805 cases, 27 620 controls). The 'post-vaccination' cohort comprised vaccinated patients with CHD and matched controls with first-recorded SARS-CoV-2 infection between 1 March 2021 and 1 April 2022, at least 14 days after vaccination (57 550 cases, 225 160 controls). Odds of severe COVID-19 outcomes were compared using conditional logistic regression. We also compared the rate at which vaccine efficacy diminished, and the incidence of vaccine-associated complications.
Results:
Compared with the prevaccination cohort, postvaccination patients with CHD exhibited markedly reduced rates of COVID-19-related hospitalisation (0.5% vs 15.8%) and mortality rates (0.5% vs 4.6%). Compared with vaccinated controls, vaccinated patients with CHD remained at increased risk of hospitalisation (0.5% vs 0.2%, adjusted OR 2.24 (1.88-2.65); p<0.001) and death (0.5% vs 0.3%, adjusted OR 1.81 (1.54-2.13); p<0.001). There was no evidence that vaccine efficacy declined faster in patients with CHD, or that patients with CHD experienced a larger increase in incidence of myocarditis, pericarditis or thrombotic events.
Conclusion:
We observed a lower absolute risk of hospitalisation and death from COVID-19 in CHD patients after vaccination. However, in vaccinated CHD patients, an elevated risk of severe outcomes persists compared with vaccinated people without CHD. These results emphasise the importance of vaccination in the CHD population, and of vigilance among care providers dealing with COVID-19 infection in CHD patients, even if fully vaccinated.
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