Hospitalized patients with congenital heart defects are up to twice as likely to have critical outcomes of COVID-19 illness compared with hospitalized COVID-19 patients without heart defects, according to research published in Circulation.
In a research letter, the authors noted that among people with congenital heart defects, critical COVID-19 outcomes, defined as ICU admission, use of a ventilator or death, were more common in those who were older or who also had other conditions like HF, pulmonary hypertension, Down syndrome, diabetes or obesity; however, children and adults with heart defects without these conditions were still at increased risk.
Karrie F. Downing
“Given the increased risk of critical outcomes from COVID-19 illness among patients with heart defects, health care providers should encourage their patients with heart defects to get vaccinated and discuss with their patients the need for other preventive measures to avoid infection,” Karrie F. Downing, MPH, an epidemiologist with the CDC’s National Center on Birth Defects and Developmental Disabilities, told Healio. “Additionally, people with heart defects should speak with their health care provider about steps they can take to manage their health and risks. Vaccination and other preventive measures for COVID-19 are important for patients with heart defects, especially those who have multiple or severe health conditions. Both clinicians and patients can also consult the CDC website regularly for updated guidance.”
Downing and colleagues compared the period prevalence of critical COVID-19 illness among 235,638 hospitalized patients with COVID-19 with and without congenital heart disease from March 2020 through January 2021, using data from the Premier Healthcare Database Special COVID-19 Release, an all-payor database representing 20% of U.S. hospital admissions. Among patients with congenital heart disease, researchers also assessed characteristics associated with critical COVID-19 illness.
Within the cohort, 421 (0.2%) had congenital heart defects. Among those patients, 68.4% had at least one comorbidity and 12.8% were children. In those without congenital heart disease, 58.8% had at least one comorbidity and 1.4% were children.
Among patients with congenital heart defects and COVID-19, 53.9% were admitted to the ICU, 24% required invasive mechanical ventilation and 11.2% died during hospitalization.
After adjustment, among patients with COVID-19, ICU admission (adjusted prevalence ratio [aPR], 1.4; 95% CI, 1.2-1.6), invasive mechanical ventilation (aPR, 1.8; 95% CI, 1.3-2.6), and death (aPR, 2; 95% CI, 1.3-3.2) were more prevalent in patients with congenital heart defects compared with those without. When stratified by high-risk characteristics, prevalence estimates for ICU admissions, mechanical ventilation and death remained higher among patients with COVID-19 with congenital heart defects vs. those without congenital heart defects, including for those without HF, pulmonary hypertension, Down syndrome, diabetes or obesity.
“The current analyses compared period prevalence of critical COVID-19 between patients with and without congenital heart defects at the same hospitals, adjusted for and stratified by established high-risk factors for severe COVID-19 infection and found up to two times higher adjusted prevalence of critical COVID-19 among patients with congenital heart defects, although results are specific to hospitalized patients,” the researchers wrote.
The researchers noted that targeted strategies are needed to increase awareness of congenital heart defects as a risk factor for critical COVID-19 illness and emphasize the critical importance of prevention of COVID-19 illness for people with congenital heart defects and their families through vaccination, masking and physical distancing.
“Not all hospitalized COVID-19 patients with heart defects had poor outcomes in our analysis, so more work is needed to identify why the clinical course of COVID-19 disease results in admission to the ICU, need for a ventilator or death for some hospitalized patients with risk factors for critical COVID-19 illness, like heart defects, and not for others,” Downing told Healio. “Additionally, the study population was hospitalized patients with COVID-19. Therefore, research to determine whether individuals with COVID-19 and heart defects are more likely to be hospitalized than individuals with COVID-19 without heart defects is needed.”
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