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Congenital Heart Defects Raise Risk of Severe COVID-19 Infection

New research from the US CDC's COVID-19 Response Team details the increased risks of severe COVID-19 infection associated with congenital heart defects.

Patients with congenital heart defects were at an increased risk of severe COVID-19 infection when hospitalized with COVID-19 compared to their counterparts with a congenital heart defect, according to new research from the US Centers for Disease Control and Prevention (CDC) COVID-19 Response Team.

An analysis of data from more than 230,000 COVID-19 hospitalizations in the US, results of the study demonstrate patients with a congenital heart defect were up to twice as likely to require intensive care, require mechanic ventilation, or die during hospitalization compared to their counterparts without a congenital heart defect.

“Data comparing COVID-19 outcomes among individuals with and without congenital heart defects has been limited,” said lead author Karrie Downing, MPH, an epidemiologist at the National Center on Birth Defects and Developmental Disabilities and the COVID-19 Response Team at the US CDC, in a statement from the American Heart Association (AHA).

Citing a lack of information related to outcomes with COVID-19 in patients without congenital heart defects, Downing and fellow investigators conducted a study leveraging data from the Premier Health are Database Special COVID-19 Release. A sample of encompassing data from approximately 20% of all US hospitalizations, investigators designed their study to assess outcomes among hospitalized COVID-19 patients treated between March 2020 and January 2021.

A total of 235,638 hospitalized patients with COVID-19 aged 1-64 years were identified for inclusion. Of these, 421 patients had a congenital heart defect. Investigators noted 68.4% with and 58.8% without a congenital heart defect had at least 1 additional comorbidity and 12.8% with a congenital heart defect were 1-17 years of age compared with 1.4% without a congenital heart defect. Investigators noted 73% of patients with a heart defect were over the age of 30 years, 61% were male, and 55% were non-Hispanic White people.

Overall, 53.9% of patients with a congenital heart defect were admitted to intensive care, 24.0% required invasive mechanical ventilation, and 11.2% died during hospitalization. In comparison, 42.6% of patients without a congenital heart defect were admitted to intensive care, 14.5% required invasive mechanical ventilation, and 6.9% died during hospitalization. After adjustment for patient characteristics results indicated the need for intensive care (aPR=1.4), need for mechanical ventilation (aPR=1.8), and death (aPR=2.0) were more prevalent among those with a congenital heart defect than those without. Among those with a congenital heart defect, critical COVID-19 outcomes were associated with having other comorbidities, male sex, and being aged 50-64 years compared to 18-29 years.

Given the results of their research, investigators highlighted the need for increased preventive efforts among patients with heart defects in the aforementioned statement from the AHA.

“People with heart defects should be encouraged to receive the COVID-19 vaccines and boosters and to continue to practice additional preventive measures for COVID-19, such as mask-wearing and physical distancing. People with heart defects should also consult with their health care teams about additional steps to manage personal risks related to COVID-19, given the significantly increased risk of severe infection and serious complications,” Downing added.

Further along in the statement, when discussing the findings from their study, investigators underlined the need for further research into increased prevalence of critical COVID-19 among congenital heart defects.

“More work is needed to identify why the clinical course of COVID-19 disease results in significantly worse outcomes for some hospitalized patients with risk factors for critical COVID-19 illness, like heart defects, and not for others,” Downing added.

This study, “Critical Illness Among Patients Hospitalized with Acute COVID-19 With and Without Congenital Heart Defects,” was published in Circulation.