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© 2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background

COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care.

Objective

Ascertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes.

Methods

Multicentre UK study undertaken 1 March 2020–30 June 2021 during the COVID-19 pandemic. Data were collected on CHD diagnoses, clinical presentation and outcomes. Multivariable logistic regression with multiple imputation was performed to explore predictors of death and hospitalisation.

Results

There were 405 reported cases (127 paediatric/278 adult). In children (age <16 years), there were 5 (3.9%) deaths. Adjusted ORs (AORs) for hospitalisation in children were significantly lower with each ascending year of age (OR 0.85, 95% CI 0.75 to 0.96 (p<0.01)). In adults, there were 24 (8.6%) deaths (19 with comorbidities) and 74 (26.6%) hospital admissions. AORs for death in adults were significantly increased with each year of age (OR 1.05, 95% CI 1.01 to 1.10 (p<0.01)) and with pulmonary arterial hypertension (PAH; OR 5.99, 95% CI 1.34 to 26.91 (p=0.02)). AORs for hospitalisation in adults were significantly higher with each additional year of age (OR 1.03, 95% CI 1.00 to 1.05 (p=0.04)), additional comorbidities (OR 3.23, 95% CI 1.31 to 7.97 (p=0.01)) and genetic disease (OR 2.87, 95% CI 1.04 to 7.94 (p=0.04)).

Conclusions

Children were at low risk of death and hospitalisation secondary to COVID-19 even with severe CHD, but hospital admission rates were higher in younger children, independent of comorbidity. In adults, higher likelihood of death was associated with increasing age and PAH, and of hospitalisation with age, comorbidities and genetic disease. An individualised approach, based on age and comorbidities, should be taken to COVID-19 management in patients with CHD.

Details

Title
COVID-19 in congenital heart disease (COaCHeD) study
Author
Chivers, Sian 1   VIAFID ORCID Logo  ; Cleary, Aoife 2 ; Knowles, Rachel 3 ; Babu-Narayan, Sonya V 4 ; Simpson, John M 5 ; Nashat, Heba 6 ; Dimopoulos, Konstantinos 6 ; Gatzoulis, Michael A 6 ; Wilson, Dirk 7 ; Prica, Milos 8 ; Anthony, James 9 ; Clift, Paul F 9 ; Jowett, Victoria 10 ; Jenkins, Petra 11 ; Khodaghalian, Bernadette 12 ; Jones, Caroline B 12   VIAFID ORCID Logo  ; Hardiman, Antonia 13 ; Head, Catherine 13 ; Miller, Owen 5 ; Natali AY Chung 14   VIAFID ORCID Logo  ; Umar Mahmood 15 ; Bu'Lock, Frances A 15 ; Ramcharan, Tristan KW 16   VIAFID ORCID Logo  ; Chikermane, Ashish 17 ; Shortland, Jennifer 18 ; Tometzki, Andrew 18 ; Crossland, David S 19   VIAFID ORCID Logo  ; Reinhardt, Zdenka 19 ; Lewis, Clive 20 ; Rittey, Leila 21 ; Hares, Dominic 22 ; Panagiotopoulou, Olga 23 ; Smith, Benjamin 23 ; Muhammad, Najih L 24 ; Bharucha, Tara 24 ; Piers EF Daubeney 25 

 Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK 
 Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK; Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK 
 Department of Public Health Medicine, Great Ormond Street Hospital for Children, London, UK; UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK 
 Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Imperial College London, London, UK 
 Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK 
 Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK 
 Department of Congenital Cardiology, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK 
 Department of Adult Congenital heart disease, Leeds Teaching Hospitals NHS Trust, Leeds, UK 
 Department of Adult Congenital heart disease, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK 
10  Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK 
11  Department of Adult Congenital heart disease, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK 
12  Department of Congenital Cardiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK 
13  Department of Adult Congenital heart disease, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK 
14  Department of Adult Congenital heart disease, St Thomas' Hospital, London, UK 
15  Department of Congenital Cardiology, Glenfield Hospital East Midlands Congenital Heart Centre, Leicester, UK 
16  Department of Congenital Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK 
17  Department of Congenital Cardiology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK 
18  Department of Congenital Cardiology, Bristol Royal Hospital for Children, Bristol, UK 
19  Department of Congenital Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK 
20  Department of Adult Congenital heart disease, Papworth Hospital, Cambridge, UK 
21  Department of Congenital Cardiology, Leeds Children's Hospital, Leeds, UK 
22  Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK 
23  Department of Congenital Cardiology, Royal Hospital for Sick Children Yorkhill, Glasgow, UK 
24  Department of Congenital Cardiology, Southampton Children's Hospital, Southampton, UK 
25  Department of Congenital Cardiology, Royal Brompton and Harefield NHS Trust, London, UK 
First page
e002356
Section
Congenital heart disease
Publication year
2023
Publication date
2023
Publisher
BMJ Publishing Group LTD
ISSN
2398595X
e-ISSN
20533624
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2838406514
Copyright
© 2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.