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. 2021 Jun 11;107(13):1069-1076.
doi: 10.1136/heartjnl-2020-317706.

Mortality and morbidity in patients with congenital heart disease hospitalised for viral pneumonia

Gerhard-Paul Diller  1   2 , Dominic Enders  3 , Astrid E Lammers  4   5 , Stefan Orwat  4 , Renate Schmidt  4 , Robert M Radke  4 , Joachim Gerss  3 , Fernando De Torres Alba  4 , Gerrit Kaleschke  4 , Ulrike M Bauer  2 , Ursula Marschall  6 , Helmut Baumgartner  4
Affiliations

Mortality and morbidity in patients with congenital heart disease hospitalised for viral pneumonia

Gerhard-Paul Diller et al. Heart. .

Abstract

Objectives: Data on the clinical outcome of patients with congenital heart disease (CHD) affected by severe viral pneumonia are limited. We analysed morbidity and mortality of viral pneumonia and evaluated the association between medical conditions, medication, vaccination and outcome specifically in patients with CHD requiring hospitalisation for viral pneumonia.

Methods: Based on data from one of Germany's largest health insurers, all cases of viral pneumonia requiring hospital admission (2005-2018) were studied. Mortality, and composites of death, transplantation, mechanical circulatory support, ventilation or extracorporeal lung support served as endpoints.

Results: Overall, 26 262 viral pneumonia cases occurred in 24 980 patients. Of these, 1180 cases occurred in patients with CHD. Compared with patients without CHD, mortality rate was elevated in patients with CHD. As a group, patients with CHD aged 20-59 years even exceeded mortality rates in patients without CHD aged >60 years. No mortality was observed in patients with CHD with simple defects <60 years of age without associated cardiovascular risk factors. On multivariable logistic regression analysis, age, CHD complexity, chromosomal anomalies, cardiac medication, use of immunosuppressants and absence of vaccination for influenza emerged as risk factors of adverse outcome.

Conclusions: We present timely data on morbidity and mortality of severe viral pneumonia requiring hospital admission in patients with CHD. Need for mechanical ventilation and risk of death in CHD increase early in life, reaching a level equivalent to non-CHD individuals >60 years of age. Our data suggest that except for patients with isolated simple defects, patients with CHD should be considered higher-risk individuals when faced with severe viral pneumonia.

Keywords: congenital heart disease.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The figure illustrates the elevated risk of death or adverse outcomes in young and middle-aged patients with congenital heart disease (CHD) that is comparable to event rates seen in elderly non-congenital individuals. Furthermore, risk factors for adverse outcome are presented. CPR, cardiopulmonary resuscitation; ECLS, extracorporeal lung support; MCS, mechanical cardiac support.
Figure 2
Figure 2
(A) Association between age and the composite endpoint of death, resuscitation, mechanical cardiac support (MCS) and transplantation in patients with congenital heart disease (CHD) and individuals without congenital heart defects showing that risk of severe complications increases early in adulthood in patients with CHD, reaching levels only seen in elderly non-congenital individuals. (B) In addition, a similar effect is seen for the composite endpoint of mechanical ventilation, extracorporeal lung support (ECLS). CPR, cardiopulmonaryresuscitation.
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