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Chivers S, Cleary A, Knowles R, Babu-Narayan SV, Simpson JM, Nashat H, Dimopoulos K, Gatzoulis MA, Wilson D, Prica M, Anthony J, Clift PF, Jowett V, Jenkins P, Khodaghalian B, Jones CB, Hardiman A, Head C, Miller O, Chung NA, Mahmood U, Bu'Lock FA, Ramcharan TK, Chikermane A, Shortland J, Tometzki A, Crossland DS, Reinhardt Z, Lewis C, Rittey L, Hares D, Panagiotopoulou O, Smith B, Najih L M, Bharucha T, Daubeney PE. COVID-19 in congenital heart disease (COaCHeD) study. Open Heart 2023; 10:e002356. [PMID: 37460271 PMCID: PMC10357297 DOI: 10.1136/openhrt-2023-002356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
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.
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Affiliation(s)
- Sian Chivers
- Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Aoife Cleary
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
- Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Rachel Knowles
- 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
| | - Sonya V Babu-Narayan
- Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - John M Simpson
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Heba Nashat
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Konstantinos Dimopoulos
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Michael A Gatzoulis
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Dirk Wilson
- Department of Congenital Cardiology, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Milos Prica
- Department of Adult Congenital heart disease, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Anthony
- Department of Adult Congenital heart disease, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul F Clift
- Department of Adult Congenital heart disease, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Victoria Jowett
- Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Petra Jenkins
- Department of Adult Congenital heart disease, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Bernadette Khodaghalian
- Department of Congenital Cardiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Caroline B Jones
- Department of Congenital Cardiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Antonia Hardiman
- Department of Adult Congenital heart disease, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Catherine Head
- Department of Adult Congenital heart disease, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Owen Miller
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Natali Ay Chung
- Department of Adult Congenital heart disease, St Thomas' Hospital, London, UK
| | - Umar Mahmood
- Department of Congenital Cardiology, Glenfield Hospital East Midlands Congenital Heart Centre, Leicester, UK
| | - Frances A Bu'Lock
- Department of Congenital Cardiology, Glenfield Hospital East Midlands Congenital Heart Centre, Leicester, UK
| | - Tristan Kw Ramcharan
- Department of Congenital Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Ashish Chikermane
- Department of Congenital Cardiology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jennifer Shortland
- Department of Congenital Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Andrew Tometzki
- Department of Congenital Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - David S Crossland
- Department of Congenital Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Zdenka Reinhardt
- Department of Congenital Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Clive Lewis
- Department of Adult Congenital heart disease, Papworth Hospital, Cambridge, UK
| | - Leila Rittey
- Department of Congenital Cardiology, Leeds Children's Hospital, Leeds, UK
| | - Dominic Hares
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Olga Panagiotopoulou
- Department of Congenital Cardiology, Royal Hospital for Sick Children Yorkhill, Glasgow, UK
| | - Benjamin Smith
- Department of Congenital Cardiology, Royal Hospital for Sick Children Yorkhill, Glasgow, UK
| | - Muhammad Najih L
- Department of Congenital Cardiology, Southampton Children's Hospital, Southampton, UK
| | - Tara Bharucha
- Department of Congenital Cardiology, Southampton Children's Hospital, Southampton, UK
| | - Piers Ef Daubeney
- Department of Congenital Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
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Pasternack D, Singh RK, Minocha PK, Farkas JS, Ramaswamy P, Better D, Verma S, Phoon CK. Characteristics of Cardiac Abnormalities in Pediatric Patients With Acute COVID-19. Cureus 2023; 15:e36093. [PMID: 37065296 PMCID: PMC10097430 DOI: 10.7759/cureus.36093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) is known to cause cardiac abnormalities in adults. Cardiac abnormalities are well-described in multisystem inflammatory syndrome in children, but effects in children with acute COVID-19 are less understood. In this multicenter study, we assessed the cardiac effects of acute COVID-19 among hospitalized children (<21 years) admitted to three large healthcare systems in New York City. Methods We performed a retrospective observational study. We examined electrocardiograms, echocardiograms, troponin, or B-type natriuretic peptides. Results Of 317 admitted patients, 131 (41%) underwent cardiac testing with 56 (43%) demonstrating cardiac abnormalities. Electrocardiogram abnormalities were the most common (46/117 patients (39%)), including repolarization abnormalities and QT prolongation. Elevated troponin occurred in 14/77 (18%) patients and B-type natriuretic peptide in 8/39 (21%) patients. Ventricular dysfunction was identified in 5/27 (19%) patients with an echocardiogram, all of whom had elevated troponin. Ventricular dysfunction resolved by first outpatient follow-up. Conclusion Electrocardiogram and troponin can assist clinicians in identifying children at risk for cardiac injury in acute COVID-19.
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Joshi SS, Keshava M, Murthy KS, Sambandamoorthy G, Shetty R, Shanmugasundaram B, Prabhu S, Hegde R, Richard VS. Coronavirus disease 2019 convalescent children: outcomes after congenital heart surgery. Cardiol Young 2021; 32:1-6. [PMID: 34706786 PMCID: PMC8649404 DOI: 10.1017/s1047951121004509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND Children with exposure to coronavirus disease 2019 in recent times (asymptomatic or symptomatic infection) approaching congenital heart surgery programme are in increasing numbers. Understanding outcomes of such children will help risk-stratify and guide optimisation prior to congenital heart surgery. OBJECTIVE The objective of the present study was to determine whether convalescent coronavirus disease 2019 children undergoing congenital heart surgery have any worse mortality or post-operative outcomes. DESIGN Consecutive children undergoing congenital heart surgery from Oct 2020 to May 2021 were enrolled after testing for reverse transcription-polymerase chain reaction or rapid antigen test and immunoglobulin G antibody prior to surgery. Convalescent coronavirus disease 2019 was defined in any asymptomatic patient positive for immunoglobulin G antibodies and negative for reverse transcription-polymerase chain reaction or rapid antigen test anytime 6 weeks prior to surgery. Control patients were negative for any of the three tests. Mortality and post-operative outcomes were compared among the groups. RESULTS One thousand one hundred and twenty-nine consecutive congenital heart surgeries were stratified as convalescence and control. Coronavirus disease 2019 Convalescent (n = 349) and coronavirus disease 2019 control (n = 780) groups were comparable for all demographic and clinical factors except younger and smaller kids in control. Convalescent children had no higher mortality, ventilation duration, ICU and hospital stay, no higher support with extracorporeal membrane oxygenation, high flow nasal cannula, no higher need for re-intubations, re-admissions, and no higher infections as central line-associated bloodstream infection, sternal site infection, and ventilator-associated pneumonia on comparison with coronavirus disease 2019 control children. CONCLUSIONS Convalescent coronavirus disease 2019 does not have any unfavourable outcomes as compared to coronavirus disease 2019 control children. Positive immunoglobulin G antibody screening prior to surgery is suggestive of convalescence and supports comparable outcomes on par with control peers.
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Affiliation(s)
- Shreedhar S Joshi
- Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Bangalore, India
| | | | - Keshava S Murthy
- Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Ganesh Sambandamoorthy
- Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Riyan Shetty
- Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Bangalore, India
| | | | - Sudesh Prabhu
- Department of Paediatric Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Rajesh Hegde
- Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Vijay S Richard
- Department of Hospital Infection Control, Narayana Institute of Cardiac Sciences, Bangalore, India
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Sabatino J, Di Salvo G, Calcaterra G, Bassareo PP, Oreto L, Cazzoli I, Calabrò MP, Guccione P, Gatzoulis MA. Adult congenital heart disease: Special considerations for COVID-19 and vaccine allocation/prioritization. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021; 4:100186. [PMID: 35360449 PMCID: PMC8206548 DOI: 10.1016/j.ijcchd.2021.100186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/14/2021] [Indexed: 01/03/2023] Open
Abstract
Individuals with the highest risk for adverse outcomes of COVID-19 should be prioritized by the vaccine allocation policies. We have conducted a literature review of published studies, which comprehend congenital heart disease (CHD) and COVID-19, in order to present the overall evidences of both exposure and clinical risk of patients with adult congenital heart disease (ACHD) and to propose a risk profile schema for those patients to be incorporated into vaccine distribution decisions.
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Affiliation(s)
- Jolanda Sabatino
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University of Padua, Padua, Italy
- Division of Cardiology, "Magna Graecia" University, Catanzaro, Italy
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Pier Paolo Bassareo
- University College of Dublin Mater Misericordiae University Hospital (National Adult Congenital Disease Service) and Our Lady's Children's Hospital Crumlin, Ireland
| | - Lilia Oreto
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Pediatric Hospital, Taormina, Messina, Italy
| | - Ilaria Cazzoli
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Pia Calabrò
- Department of Human Pathology of Adulthood and Childhood - Pediatric Cardiology Unit, University of Messina, Messina, Italy
| | - Paolo Guccione
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre, National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College, London, UK
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