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. 2021 Jul 12;107(15):1226-1232.
doi: 10.1136/heartjnl-2020-318467.

Clinical outcome of COVID-19 in patients with adult congenital heart disease

Markus Schwerzmann  1 , Francisco Javier Ruperti-Repilado  2 , Helmut Baumgartner  3 , Berto Bouma  4 , Judith Bouchardy  5   6 , Werner Budts  7   8 , Laurence Campens  9 , Massimo Chessa  10 , Maria Jesús Del Cerro Marin  11 , Harald Gabriel  12 , Pastora Gallego  13 , Rocio Garcia-Orta  14 , Ana Elvira Gonzalez  15 , Annette Schophuus Jensen  16 , Magalie Ladouceur  17 , Berta Miranda-Barrio  18 , Marielle Morissens  19 , Agnes Pasquet  20 , Joaquín Rueda  21 , Annemien E van den Bosch  22 , Heleen Berdina van der Zwaan  23 , Daniel Tobler  24 , Matthias Greutmann  25 ; EPOCH
Collaborators, Affiliations

Clinical outcome of COVID-19 in patients with adult congenital heart disease

Markus Schwerzmann et al. Heart. .

Abstract

Aims: Patients with adult congenital heart disease (ACHD) are a potentially vulnerable patient cohort in case of COVID-19. Some cardiac defects may be associated with a poor COVID-19 outcome. Risk estimation in ACHD is currently based on expert opinion. The aim of this study was to collect clinical outcome data and to identify risk factors for a complicated course of COVID-19 in patients with ACHD.

Methods: Twenty-five ACHD centres in nine European countries participated in the study. Consecutive patients with ACHD diagnosed with COVID-19 presenting to one of the participating centres between 27 March and 6 June 2020 were included. A complicated disease course was defined as hospitalisation for COVID-19 requiring non-invasive or invasive ventilation and/or inotropic support, or a fatal outcome.

Results: Of 105 patients with a mean age of 38±13 years (58% women), 13 had a complicated disease course, of whom 5 died. In univariable analysis, age (OR 1.3, 95% CI 1.1 to 1.7, per 5 years), ≥2 comorbidities (OR 7.1, 95% CI 2.1 to 24.5), body mass index of >25 kg/m2 (OR 7.2, 95% CI 1.9 to 28.3) and cyanotic heart disease (OR 13.2, 95% CI 2.5 to 68.4) were associated with a complicated disease course. In a multivariable logistic regression model, cyanotic heart disease was the most important predictor (OR 60.0, 95% CI 7.6 to 474.0).

Conclusions: Among patients with ACHD, general risk factors (age, obesity and multiple comorbidities) are associated with an increased risk of complicated COVID-19 course. Congenital cardiac defects at particularly high risk were cyanotic lesions, including unrepaired cyanotic defects or Eisenmenger syndrome.

Keywords: congenital; heart defects.

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Conflict of interest statement

Competing interests: WB declared being proctor of Abbott and Occlutech.

Figures

Figure 1
Figure 1
Univariable significant COVID-19 risk factors in patients with adult congenital heart disease and the corresponding ORs. We propose to stratify patients based on age, number of comorbidities, weight and presence of a high-risk cardiac lesion (cyanotic heart disease). BMI, Body Mass Index.
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