Clinical outcome of COVID-19 in patients with adult congenital heart disease
Markus Schwerzmann, Francisco Javier Ruperti‐Repilado, Helmut Baumgartner, Berto J. Bouma, Judith Bouchardy, Werner Budts, Laurence Campens, Massimo Chessa, María Jesús del Cerro Marín, Harald Gabriel, Pastora Gallego, Rocío García‐Orta, Ana González, Annette Schophuus Jensen, Magalie Ladouceur, Berta Miranda, Marielle Morissens, Agnès Pasquet, Joaquı́n Rueda, Annemien E. van den Bosch, Heleen B. van der Zwaan, Daniel Tobler, Matthias Greutmann
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: (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.