COVID-19 in congenital heart disease (COaCHeD) study

Sian Chivers; Aoife Cleary; Rachel Knowles; Sonya V Babu-Narayan; John M Simpson; Heba Nashat; Konstantinos Dimopoulos; Michael A Gatzoulis; Dirk Wilson; Milos Prica; James Anthony; Paul F Clift; Victoria Jowett; Petra Jenkins; Bernadette Khodaghalian; Caroline B Jones; Antonia Hardiman; Catherine Head; Owen Miller; Natali Ay Chung; Umar Mahmood; Frances A Bu'Lock; Tristan Kw Ramcharan; Ashish Chikermane; Jennifer Shortland; Andrew Tometzki; David S Crossland; Zdenka Reinhardt; Clive Lewis; Leila Rittey; Dominic Hares; Olga Panagiotopoulou; Benjamin Smith; Muhammad Najih L; Tara Bharucha; Piers Ef Daubeney

doi:10.1136/openhrt-2023-002356

COVID-19 in congenital heart disease (COaCHeD) study

Open Heart. 2023 Jul;10(2):e002356. doi: 10.1136/openhrt-2023-002356.

Authors

Sian Chivers^{1

2}, Aoife Cleary^{2

3}, Rachel Knowles^{4

5}, Sonya V Babu-Narayan^{1

6}, John M Simpson², Heba Nashat⁷, Konstantinos Dimopoulos⁷, Michael A Gatzoulis⁷, Dirk Wilson⁸, Milos Prica⁹, James Anthony¹⁰, Paul F Clift¹⁰, Victoria Jowett³, Petra Jenkins¹¹, Bernadette Khodaghalian¹², Caroline B Jones¹², Antonia Hardiman¹³, Catherine Head¹³, Owen Miller², Natali Ay Chung¹⁴, Umar Mahmood¹⁵, Frances A Bu'Lock¹⁵, Tristan Kw Ramcharan¹⁶, Ashish Chikermane¹⁷, Jennifer Shortland¹⁸, Andrew Tometzki¹⁸, David S Crossland¹⁹, Zdenka Reinhardt¹⁹, Clive Lewis²⁰, Leila Rittey²¹, Dominic Hares²², Olga Panagiotopoulou²³, Benjamin Smith²³, Muhammad Najih L²⁴, Tara Bharucha²⁴, Piers Ef Daubeney²⁵

Affiliations

¹ Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
² Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK.
³ Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK.
⁴ Department of Public Health Medicine, Great Ormond Street Hospital for Children, London, UK.
⁵ UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK.
⁶ Imperial College London, London, UK.
⁷ Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
⁸ Department of Congenital Cardiology, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK.
⁹ Department of Adult Congenital heart disease, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁰ Department of Adult Congenital heart disease, University Hospitals Birmingham NHS Foundation Trust, Birmingham, 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 p.daubeney@rbht.nhs.uk.

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.

Keywords: COVID-19; EPIDEMIOLOGY; Heart Defects, Congenital; RISK FACTORS.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
COVID-19* / complications
COVID-19* / therapy
Child
Familial Primary Pulmonary Hypertension
Heart Defects, Congenital* / diagnosis
Heart Defects, Congenital* / epidemiology
Heart Defects, Congenital* / therapy
Hospitalization
Humans
Pandemics
Pulmonary Arterial Hypertension*

Grants and funding

FS/11/38/28864/BHF_/British Heart Foundation/United Kingdom