COVID-19 in Adults With Congenital Heart Disease

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.

Keywords: COVID-19; adult congenital heart disease; coronavirus; hospitalization.

Graphical abstract

Figure 1

Global Distribution of Contributing Centers Points identify the location of the 58 congenital heart centers participating in the study.

Figure 2

Distribution of the Study Cohort Anatomic and/or Physiological Categorization Column heights indicate the percentage of each anatomic and/or physiologic subtype from the total cohort. Classification is based on the scheme as outlined in the American College of Cardiology/American Heart Association 2018 guidelines for adult congenital heart disease (9).

Figure 3

Histogram by Age and Major Outcome Columns show the study population by decade of age, with severe cases (red) and deaths (gray) indicated within each.

Central Illustration

Major Outcome by Defect Type Breakdown of the entire cohort by congenital defect category. Those with severe disease exclusive of death (red) and fatal cases (gray) are indicated, with percentage by category. ∗Groups that were not exclusive of others; patients with cyanosis, pulmonary hypertension, or Fontan are pooled regardless of underlying anatomy. All other groups are mutually exclusive. Age distribution is given for each category. Conotruncal abnormalities include tetralogy of Fallot, pulmonary atresia with ventricular septal defect, and truncus arteriosus. LV = left ventricle; RV= right ventricle; TGA = transposition of the great arteries.