COVID-19 in Adults With Congenital Heart Disease

• Authors: Fred Rodriguez III, Emory University; Craig S Broberg, Oregon Health & Science University; Adrienne H Kovacs, Oregon Health & Science University; Soraya Sadeghi, Ahmanson UCLA Adult Congenital Heart Ctr; Marlon S Rosenbaum, Columbia University; Matthew J Lewis, Columbia University; Matthew R Carazo, Emory University; Fred H Rodriguez, Emory University; Dan G Halpern, York University Langone Health; Jodi Feinberg, York University Langone Health; Francisca Arancibia Galilea, Instituto Nacional del Tórax - Pontificia Universidad Católica de Chile; Fernando Baraona, Instituto Nacional del Tórax - Pontificia Universidad Católica de Chile; Ari M Cedars, Johns Hopkins University; Jong M Ko, Johns Hopkins University; Prashob Porayette, University of Iowa; Jennifer Maldonado, University of Iowa; Berardo Sarubbi, Monaldi Hospital; Flavia Fusco, Monaldi Hospital; Alexandra A Frogoudaki, ATTIKON University Hospital; Amiram Nir, Shaare Zedek Medical Center; Anisa Chaudhry, Penn State Hershey Heart and Vascular Institute; Anitha S John, Children’s National Hospital, Washington; Arsha Karbassi, McMaster University; Arvind K Hoskoppal, UPMC Adult Congenital Heart Disease Program; Benjamin P Frischhertz, Vanderbilt University; Benjamin Hendrickson, University of Tennessee; Berto J Bouma, University of Amsterdam; Carla P Rodriguez-Monserrate, Boston Childrens Hospital; Christopher R Broda, Baylor College of Medicine; Daniel Tobler, University Hospital of Basel; David Gregg, Medical University of South Carolina; Efren Martinez-Quintana, Universitario Insular-Materno Infantil; Elizabeth Yeung, Colorado’s Adult and Teen Congenital Heart Program; Eric Krieger, University of Washington; Francisco J Ruperti-Repilado, University Hospital Geneva; George Giannakoulas, Ahepa University Hospital; George K Lui, Stanford University; Georges Ephrem, Indiana University School of Medicine; Harsimran S Singh, New York Presbyterian Hospital; Hassan MK Almeneisi, Cincinnati Childrens Hospital Medical Center; Heather L Bartlett, University of Wisconsin; Ian Lindsay, University of Utah; Jasmine Grewal, University of British Columbia; Jeremy Nicolarsen, Providence Adult & Teen Congenital Heart Program; John J Araujo, Somer Incare Cardiovasc Centre; Jonathan W Cramer, University of Nebraska Medical Center; Judith Bouchardy, University Hospital Lausanne; Khalid Al Najashi, Prince Sultan Cardiac Center; Kristi Ryan, OSF Healthcare Childrens Hospital Illinois; Laith Alshawabkeh, University of California San Diego; Lauren Andrade, University of Pennsylvania; Magalie Ladouceur, Hôpital Européen Georges Pompidou; Markus Schwerzmann, University Hospital Inselspital; Matthuas Greutmann, University of Zurich; Pablo Meras, Hospital Universitario La Paz; Paolo Ferrero, University of Milan; Payam Dehghani, University of Saskatchewan; Poyee P Tung, University Texas Houston; Rocio Garcia-Orta, Hospital Universitario Virgen de las Nieves; Rose O Tompkins, Cedars-Sinai Medical Center; Salwa M Gendi, West Virginia University; Scott Cohen, Medical College of Wisconsin; Scott Klewer, University of Arizona; Sebastien Hascoet, Hopital Marie Lannelongue; Shabnam Mohammadzadeh, Tehran University of Medical Sciences; Shailendra Upadhyay, Connecticut Children’s Medical Center; Stacy D Fisher, University of Maryland School of Medicine; Stephen Cook, Helen DeVos Childrens Hosp; Timothy B Cotts, University of Michigan; Jamil A Aboulhosn, Ahmanson UCLA Adult Congenital Heart Ctr
• Journal Title: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
• Volume: Volume 77, Number 13
• Publisher: ELSEVIER SCIENCE INC | 2021-03-29, Pages 1644-1655
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.jacc.2021.02.023
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; adult congenital heart disease; coronavirus; COVID-19; hospitalization; UNITED-STATES; RISK; HOSPITALIZATION; CONSEQUENCES; INFLUENZA

Abstract

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.