COVID-19 in adults with congenital heart disease: early morbidity and mortality in two northern Italian specialist centers
Abstract
There is no information on coronavirus disease 2019 (COVID-19)-related outcomes for adult patients with congenital heart disease (ACHD). We aim to assess the clinical burden of COVID-19 on ACHD patients during the initial stages of the pandemic in Europe. ACHD patients followed in 2 tertiary centers in the Lombardy region were screened for COVID-19-related symptoms and complications. 661 patients (52.3% male, mean age 34.9±11.7 years) with CHD of moderate (58.5%) or high (32.8%) complexity were contacted. Of these, 145 (21.9%) reported typical COVID-19 symptoms, but only 4.8% required hospitalization. We did not record confirmed COVID-19-related deaths. Patients hospitalized were elderly (P=0.03), more likely to be receiving diuretics (P=0.03) or beta-blockers (P=0.02), and have been admitted over the previous year (P=0.003). Of the 7 patients hospitalized, 2 had a systemic RV and 2 a Fontan circulation. COVID-19-related morbidity and mortality have been low in ACHD patients 6 weeks from the start of the outbreak, in one of the worse hit European regions.
References
- Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020 [Epub ahead of print]. DOI: https://doi.org/10.1001/jama.2020.5394
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. DOI: https://doi.org/10.1016/S0140-6736(20)30183-5
- Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic. J Am Coll Cardiol 2020. [Epub ahead of print]. DOI: https://doi.org/10.1016/j.jacc.2020.03.031
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;0. [Epub ahead of print].
- Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;73:1494-563. DOI: https://doi.org/10.1016/j.jacc.2018.08.1028
- Tan W, Aboulhosn J. The cardiovascular burden of coronavirus disease 2019 (COVID-19) with a focus on congenital heart disease. Int J Cardiol 2020 [Epub ahead of print]. DOI: https://doi.org/10.1016/j.ijcard.2020.03.063
- Elkind MSV, Harrington RA, Benjamin IJ. The role of the American Heart Association in the global COVID-19 pandemic. Circulation 2020;141:e743-5. DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.046749
- Skulstad H, Cosyns B, Popescu BA, et al. COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel. Eur Heart J Cardiovasc Imaging 2020 [Epub ahead of print]. DOI: https://doi.org/10.1093/ehjci/jeaa072
- Lakkireddy DR, Chung MK, Gopinathannair R, et al. Guidance for cardiac electrophysiology during the coronavirus (COVID-19) pandemic from the Heart Rhythm Society COVID-19 task force; Electrophysiology section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association. Circulation 2020 [Epub ahead of print]. DOI: https://doi.org/10.1016/j.hrthm.2020.03.028
- Warnes CA, Liberthson R, Danielson GK, et al. Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol 2001;37:1170-5. DOI: https://doi.org/10.1016/S0735-1097(01)01272-4
- Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging 2020;12. [Epub ahead of print]. DOI: https://doi.org/10.18632/aging.103000
- Organization WH. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19): interim guidance, 19 March 2020. [Epub ahead of print].
- Beeching NJ, Fletcher TE, Beadsworth MBJ. Covid-19: testing times. BMJ 2020;369:m1403. DOI: https://doi.org/10.1136/bmj.m1403
- Tutarel O, Alonso-Gonzalez R, Montanaro C, et al. Infective endocarditis in adults with congenital heart disease remains a lethal disease. Heart Br Card Soc 2018;104:161-5. DOI: https://doi.org/10.1136/heartjnl-2017-311650
- Constantine A, Barradas-Pires A, Dimopoulos K. Modifiable risk factors in congenital heart disease: Education, transition, digital health and choice architecture. Eur J Prev Cardiol 2019:2047487319874146. DOI: https://doi.org/10.1177/2047487319874146
- Wang K, Gheblawi M, Oudit GY. Angiotensin converting enzyme 2: a double-edged sword. Circulation 2020 [Epub ahead of print]. DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.047049
- Yang H, Bouma BJ, Dimopoulos K, et al. Non-vitamin K antagonist oral anticoagulants (NOACs) for thromboembolic prevention, are they safe in congenital heart disease? Results of a worldwide study. Int J Cardiol 2020;299:123-30. DOI: https://doi.org/10.1016/j.ijcard.2019.06.014
- Matchar DB, Jacobson A, Dolor R, et al. Effect of home testing of international normalized ratio on clinical events. N Engl J Med 2010;363:1608-20. DOI: https://doi.org/10.1056/NEJMoa1002617
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