Congenital Heart Disease Does Not Increase COVID-19 Risk, Severity

A study analyzing COVID-19 risk and outcomes in patients with congenital heart disease (CHD) found that CHD in itself was not a risk factor, but patients with a genetic syndrome and adults at advanced physiological stage were at risk for moderate/severe disease.

“At the beginning of the pandemic, many feared that congenital heart disease would be as big a risk factor for COVID-19 as adult-onset cardiovascular disease,” according to the researchers.

They retrospectively reviewed CHD patients at Columbia University Irving Medical Center who received a COVID-19 diagnosis between March 1 and July 1. The main outcome measure was moderate/severe COVID-19 response, defined as death or need for hospitalization and/or respiratory support secondary to COVID-19 infection.

Final analysis included 53 COVID-19 and CHD patients, 10 of whom (19%) were aged <18 years; the median age overall was 34 years. Thirty-one patients (58%) had complex congenital anatomy (10 [19%] had a Fontan repair); eight patients (15%) had a genetic syndrome, six (11%) had pulmonary hypertension, and nine (17%) were obese. About two in five of the adults (n=18; 41%) were physiologic class C or D.

Nine patients (17%) had a moderate/severe infection, three of whom (6%) died. The most significant risk factors for moderate/severe infection were the presence of a genetic syndrome (odds ratio [OR]=35.82; P=0.0002) and (among adults) physiological stage C or D (OR=19.38; P=0.002).

More specifically, there were five patients with trisomy 21, four with Eisenmenger’s syndrome, and two with DiGeorge syndrome. The majority of patients with trisomy 21 and DiGeorge syndrome had moderate/severe COVID-19 symptoms.

“While it is possible that our patient population exercised stricter adherence to social distancing given early publicized concerns about cardiac risk, these early results appear reassuring,” the researchers stated.

Despite the study’s small sample size, they added, “these results imply that specific congenital heart lesions may not be sufficient cause alone for severe COVID-19 infection.”

The study was published in the Journal of the American Heart Association.

“Despite evidence that adult-onset cardiovascular disease is a risk factor for worse outcomes among patients with COVID-19, patients with CHD without concomitant genetic syndrome, and adults who are not at advanced physiological stage, do not appear to be disproportionately impacted,” they concluded.