COVID-19 in Adults With Congenital Heart Disease

Quick Takes

  • The presence of a structural congenital heart defect did not necessarily portend an increased risk of mortality or morbidity from COVID-19 infection.
  • Susceptibility might be based on physiological factors, not the complexity of the underlying anatomic defect.
  • Targeted preventive measures are indicated for patients with congenital heart disease at greatest risk of mortality and severe morbidity from COVID-19 such as those with Eisenmenger syndrome.

Study Questions:

What is the impact of coronavirus disease 2019 (COVID-19) in adults with congenital heart disease (CHD), and what are the risk factors associated with adverse outcomes?

Methods:

The investigators included adults (ages ≥18 years) with CHD and with confirmed or clinically suspected COVID-19 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. Odds ratios with 95% confidence intervals (CIs) were determined using logistic regression to report the strength of association between risk factor exposure and mortality.

Results:

From 58 adult CHD centers, the study included 1,044 infected patients (age, 35.1 ± 13.0 years; range, 18-86 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% CI, 1.4-3.2%). 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:

The authors concluded that COVID-19 mortality in adults with CHD is commensurate with the general population.

Perspective:

This study reports that the presence of a structural congenital heart defect did not necessarily portend an increased risk of mortality or morbidity from COVID-19 infection. However, several factors were associated with mortality and severe infections including cyanosis and pulmonary hypertension, especially when combined (Eisenmenger syndrome). Furthermore, susceptibility might be based on physiological factors, not the complexity of the underlying anatomic defect, and are concordant with general population studies that showed risks associated with age, male sex, diabetes, and renal insufficiency. Targeted preventive measures are indicated for patients with CHD who are at greatest risk of mortality and severe morbidity due to COVID-19 such as those with Eisenmenger syndrome.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Pulmonary Hypertension, Echocardiography/Ultrasound

Keywords: Coronavirus, COVID-19, Cyanosis, Diabetes Mellitus, Echocardiography, Eisenmenger Complex, Heart Defects, Congenital, Heart Failure, Hypertension, Pulmonary, Morbidity, Renal Insufficiency, Risk Factors, Secondary Prevention


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