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Congenital heart defects may not increase the risk of severe COVID-19 symptoms

Adults and children born with heart defects had a lower-than-expected risk of developing moderate or severe COVID-19 symptoms, finds a study of more than 7,000 patients from the congenital heart disease center at Columbia University Vagelos College of Physicians and Surgeons.

Throughout the course of the pandemic, evidence has shown that individuals with heart disease have a higher risk of life-threatening illness and complications from COVID-19. But the impact of SARS-CoV-2 infection on individuals with congenital heart defects, who are generally younger than those with adult-onset heart disease, was unknown.

About 1% (40,000) of babies born each year in the United States have one or more heart defects.

“At the beginning of the pandemic, many feared that congenital heart disease would be as big a risk factor for severe COVID-19 as adult-onset cardiovascular disease,” says Matthew Lewis, MD, assistant professor of medicine at Columbia University Vagelos College of Physicians and Surgeons and co-leader of the study. “We were reassured by the low number of congenital heart patients who required hospitalization for COVID-19 and the relatively good outcomes of these patients.”

Few congenital heart patients had COVID-19


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Only 53 congenital heart patients (43 adults and 10 children)–less than 0.8% of patients at Columbia’s congenital heart center–presented to their physician with symptoms of SARS-CoV-2 infection from March through June. (During the study period, an estimated 20% of people in the New York metropolitan area are thought to have been infected with the coronavirus.)

More than 80% (43) of these patients had mild symptoms. Of the 9 patients who developed moderate to severe symptoms, 3 died. (Another study performed at Columbia University Irving Medical Center during the same period found that roughly 22% of hospitalized patients from the general population became critically ill and about one-third of those patients died.)

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In the new study, the researchers found that patients with a genetic syndrome and adults with advanced disease from their congenital heart defect were more likely to develop moderate to severe symptoms, though an individual’s type of congenital heart defect did not impact symptoms severity.

Though the study sample was small, the researchers conclude that congenital heart disease alone may not be enough to increase the risk of severe COVID-19 symptoms.

Caveats


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It’s unlikely that people with congenital heart disease have an intrinsically lower risk of becoming severely ill from the new coronavirus, and the researchers hypothesize that the patients in this study may have adhered more strictly to social distancing guidelines compared with the general population, given the publicity about increased COVID-19 risk in patients with heart disease.

The researchers caution that individuals with congenital heart disease should continue to practice strict social distancing and follow all CDC guidelines as these measures are likely contributing to the study findings.


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They also note that the younger average age (34 years) of these patients and lower incidence of acquired cardiac risk factors compared with other individuals who had severe COVID-19 may explain why fewer congenital heart patients than expected had severe symptoms.

“It’s possible that elderly patients with congenital heart disease might have a different risk profile than the general population,” adds Brett Anderson, Florence Irving Assistant Professor of Pediatrics at Columbia University Vagelos College of Physicians and Surgeons and co-leader of the study. “We have yet to define what those risk factors are.”

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Source:

Columbia University Irving Medical Center

Journal Reference:


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The Impact of Coronavirus disease 2019 (COVID‐19) on Patients with Congenital Heart Disease across the Lifespan: The Experience of an Academic Congenital Heart Disease Center in New York City

Abstract
Background
We sought to assess the impact and predictors of Coronavirus Disease 2019 (COVID‐19) infection and severity in a cohort of congenital heart disease (CHD) patients at a large CHD center in New York City.

Methods and Results
We performed a retrospective review of all individuals with CHD followed at Columbia University Irving Medical Center who were diagnosed with COVID‐19 between 3/1/2020 and 7/1/2020. The primary endpoint was moderate/severe response to COVID‐19 infection defined as a) death during COVID‐19 infection; or 2) need for hospitalization and/or respiratory support secondary to COVID‐19 infection.

Among 53 COVID‐19 positive patients with CHD, 10 (19%) were <18 years old (median age 34 years). 31 (58%) had complex congenital anatomy including 10 (19%) with a Fontan repair. Eight (15%) had a genetic syndrome, six (11%) had pulmonary hypertension (PH), and nine (17%) were obese.

Among adults, 18 (41%) were physiologic class C or D. For the entire cohort, nine (17%) had a moderate/severe infection, including three deaths (6%). After correcting for multiple comparisons, the presence of a genetic syndrome (OR=35.82: p=0.0002), and in adults, physiological Stage C or D (OR=19.38: p=0.002) were significantly associated with moderate/severe infection.

Conclusions
At our CHD center, the number of symptomatic COVID‐19 patients was relatively low. CHD patients with a genetic syndrome and adults at advanced physiological stage were at highest risk for moderate/severe infection.

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