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COVID-19 in Adults With Congenital Heart Disease
Authors:Craig S Broberg  Adrienne H Kovacs  Soraya Sadeghi  Marlon S Rosenbaum  Matthew J Lewis  Matthew R Carazo  Fred H Rodriguez  Dan G Halpern  Jodi Feinberg  Francisca Arancibia Galilea  Fernando Baraona  Ari M Cedars  Jong M Ko  Prashob Porayette  Jennifer Maldonado  Berardo Sarubbi  Flavia Fusco  Alexandra A Frogoudaki  Jamil A Aboulhosn
Institution:1. Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA;2. Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA;3. Division of Cardiology, Columbia University Medical Center, New York, New York, USA;4. Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA;5. Division of Cardiology, York University Langone Health, New York, New York, USA;6. Instituto Nacional del Tórax - Pontificia Universidad Católica de Chile, Santiago, Chile;7. Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;8. Division of Cardiology, University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa, USA;9. Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy;10. Second Cardiology Department, ATTIKON University Hospital, Athens, Greece;11. Shaare Zedek Medical Center, Jerusalem, Israel;12. Penn State Hershey Heart and Vascular Institute, State College, Pennsylvania, USA;13. Division of Cardiology, Children’s National Hospital, Washington, DC, USA;14. McMaster University, Hamilton, Ontario, Canada;15. UPMC Adult Congenital Heart Disease Program, Pittsburgh, Pennsylvania, USA;p. Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA;q. University of Tennessee Health Science Center, Le Bonheur Heart Institute, Memphis, Tennessee, USA;r. Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands;s. Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA;t. Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA;u. Division of Cardiology, University Hospital of Basel, Basel, Switzerland;v. Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA;w. Cardiology Service, Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain;x. Anschutz Medical Campus, Colorado’s Adult and Teen Congenital Heart Program, Aurora, Colorado, USA;y. Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA;z. Division of Cardiology, University Hospital Geneva, Geneva, Switzerland;11. Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece;22. Division of Cardiovascular Medicine and Pediatric Cardiology, Stanford University School of Medicine, Stanford, California, USA;33. Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA;44. Weill Cornell Medicine, New York Presbyterian Hospital, Department of Medicine and Pediatrics, New York, New York, USA;55. Cincinnati Children’s Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA;66. Department of Pediatrics and Medicine, University of Wisconsin, Madison, Wisconsin, USA;77. Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, USA;88. University of British Columbia, St. Paul’s Hospital, Vancouver, British Colombia, Canada;99. Providence Adult and Teen Congenital Heart Program, Pediatric and Adult Cardiology, Spokane, Washington, USA;1010. Department of Pediatric and Adult Congenital Heart Disease, Somer Incare Cardiovascular Center, Rionegro, Colombia;1111. Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA;1212. Department of Cardiology and Cardiac Surgery, University Hospital Lausanne, Lausanne, Switzerland;1313. Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia;1414. OSF Healthcare Children’s Hospital of Illinois, Adult Congenital Heart Program, Peoria, Illinois, USA;1515. Department of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA;pp. Division of Cardiology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA;qq. Hôpital Européen Georges Pompidou, Adult Congenital Heart Disease Unit, Paris, France;rr. University Hospital Inselspital, Center for Congenital Heart Disease, Bern, Switzerland;ss. Department of Cardiology, University of Zurich, Zurich, Switzerland;tt. University Hospital La Paz, Madrid, Spain;uu. ASST Papa Giovanni XXIII, Cardiovascular Department, University of Milano, Bergamo, Italy;vv. Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada;ww. University of Texas at Houston, Adult Congenital Heart Disease, Houston, Texas, USA;xx. Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain;yy. Cedars-Sinai Medical Center, The Geurin Family Congenital Heart Program, Los Angeles, California, USA;zz. West Virginia University, Adult Congenital Heart Disease Program, Morgantown, West Virginia, USA;111. Medical College of Wisconsin, Adult Congenital Heart Disease Program, Milwaukee, Wisconsin, USA;222. Division of Cardiology, University of Arizona, Tucson, Arizona, USA;333. Hôpital Marie Lannelongue, Le Plessis Robinson, France;444. Tehran University of Medical Sciences, Tehran, Iran;555. Connecticut Children’s Medical Center, Pediatric Cardiology Hartford, Connecticut, USA;666. Department of Medicine and Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA;777. Helen DeVos Children’s Hospital, Adult Congenital Heart Center, Grand Rapids, Michigan, USA;888. Department of Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
Abstract:BackgroundAdults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications.ObjectivesThis study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes.MethodsAdults (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.ResultsFrom 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.ConclusionsCOVID-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.
Keywords:adult congenital heart disease  coronavirus  COVID-19  hospitalization  CHD"}  {"#name":"keyword"  "$":{"id":"kwrd0035"}  "$$":[{"#name":"text"  "_":"congenital heart disease  CI"}  {"#name":"keyword"  "$":{"id":"kwrd0045"}  "$$":[{"#name":"text"  "_":"confidence interval  COVID-19"}  {"#name":"keyword"  "$":{"id":"kwrd0055"}  "$$":[{"#name":"text"  "_":"coronavirus disease-2019  eGFR"}  {"#name":"keyword"  "$":{"id":"kwrd0065"}  "$$":[{"#name":"text"  "_":"estimated glomerular filtration rate  ICU"}  {"#name":"keyword"  "$":{"id":"kwrd0075"}  "$$":[{"#name":"text"  "_":"intensive care unit  OR"}  {"#name":"keyword"  "$":{"id":"kwrd0085"}  "$$":[{"#name":"text"  "_":"odds ratio  PAH"}  {"#name":"keyword"  "$":{"id":"kwrd0095"}  "$$":[{"#name":"text"  "_":"pulmonary arterial hypertension  PCR"}  {"#name":"keyword"  "$":{"id":"kwrd0105"}  "$$":[{"#name":"text"  "_":"polymerase chain reaction
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