COVID-19 More Severe Among Some People With Congenital Heart Disease

By Will Boggs MD

October 22, 2020

NEW YORK (Reuters Health) - Patients whose congenital heart disease (CHD) stems from a genetic syndrome or is more physiologically advanced face an increased risk of moderate/severe COVID-19, according to a new review.

"Besides the relatively low numbers of individuals with congenital heart disease presenting with severe COVID-19 symptoms, we were most surprised by the fact that type of congenital heart disease was not a strong risk factor for infection severity," said Dr. Matthew J. Lewis of Columbia University Irving Medical Center, in New York City.

"Many of our patients have very complex cardiac physiology as a consequence of their congenital heart disease and subsequent repair, and, according to our data, that alone does not appear to be sufficient cause for severe COVID-19 symptoms," he told Reuters Health by email.

Patients with cardiovascular risk factors fare worse with COVID-19, but the impact of COVID-19 on individuals with CHD has been unclear.

Dr. Lewis and colleagues evaluated the outcomes of COVID-19 among 53 individuals with CHD who were diagnosed between March and July.

CHD diagnoses included tetralogy of Fallot or pulmonary stenosis (16 patients, 30%), single-ventricle-physiology status post Fontan palliation (10, 19%), shunting defects (six, 11%), congenital valve abnormality (seven, 13%), atrioventricular canal defects (seven, 13%), and seven patients (13%) with other diagnoses.

Most patients (43, 81%) reported only mild symptoms, whereas seven adults and two children (17%) experienced moderate/severe symptoms. Seven patients with moderate/severe symptoms required hospitalization.

Three patients died, including two living in long-term care facilities at the time of infection.

Factors independently associated with moderate/severe infection included a concurrent genetic syndrome and, in adult patients, more advanced physiological stage (stage C or D using the American College of Cardiology/American Heart Association Adult Congenital Heart Disease Guidelines).

Symptoms lasted a mean 12 days, and the mean duration of symptoms was significantly longer among individuals with decreased subsystemic, subpulmonic, or single-ventricular function (18 days) than among other individuals (nine days).

There was no significant association between symptom duration and age, type of CHD, history of pulmonary hypertension, BMI, or category of most recent surgery, the researchers report in the Journal of the American Heart Association.

"Our understanding of the impact of COVID-19 on the congenital heart disease community continues to evolve, and future multicenter studies will be able to provide more specific detail regarding individual risk factors," Dr. Lewis said,

However, he added, "early data suggests that the most important predictor for severe COVID-19 in individuals with congenital heart disease who do not have an underlying genetic syndrome is their overall degree of pre-infection cardiac decompensation."

"Everyone with congenital heart disease should take care to ensure they are following all recommendations pertaining to social distancing, as such efforts likely contributed to our results," he said. "In particular, those individuals who are at late physiological stage, which includes those with a poor functional class, heart failure, significant valvular disease, resting hypoxemia, a history of arrhythmias or end-organ dysfunction, and those who may have an underlying genetic abnormality may be at highest risk of severe COVID-19 symptoms and should be extra attentive."

Dr. Tarek Alsaied, a pediatric cardiologist at Cincinnati Children's Hospital Medical Center's Heart Institute, in Ohio, recently outlined 10 points to remember when managing COVID-19 in CHD patients. He told Reuters Health by email, "We are pleasantly surprised that children with congenital heart disease didn't seem to have very high incidence, morbidity, or mortality due to COVID infection. Despite that, we still recommend social distancing and carefulness to avoid infection with COVID 19."

"Children with congenital heart disease generally should be treated like other children in regards to preventing COVID 19 infection with careful consultation with the cardiologist," said Dr. Alsaied, who was not involved in the study.

SOURCE: Journal of the American Heart Association, online October 14, 2020.