COVID-19 in Adults With Congenital Heart Disease.
Adult
COVID-19
/ mortality
COVID-19 Testing
/ methods
Cardiac Surgical Procedures
/ methods
Causality
Comorbidity
Cyanosis
/ diagnosis
Female
Global Health
/ statistics & numerical data
Heart Defects, Congenital
/ classification
Hospitalization
/ statistics & numerical data
Humans
Hypertension, Pulmonary
/ diagnosis
Male
Mortality
Patient Acuity
Risk Factors
SARS-CoV-2
/ isolation & purification
Symptom Assessment
COVID-19
adult congenital heart disease
coronavirus
hospitalization
Journal
Journal of the American College of Cardiology
ISSN: 1558-3597
Titre abrégé: J Am Coll Cardiol
Pays: United States
ID NLM: 8301365
Informations de publication
Date de publication:
06 04 2021
06 04 2021
Historique:
received:
17
12
2020
revised:
01
02
2021
accepted:
08
02
2021
entrez:
2
4
2021
pubmed:
3
4
2021
medline:
13
4
2021
Statut:
ppublish
Résumé
Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 33795039
pii: S0735-1097(21)00397-1
doi: 10.1016/j.jacc.2021.02.023
pmc: PMC8006800
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1644-1655Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL007572
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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