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Ruperti-Repilado FJ, Baumgartner H, Bouma B, Bouchardy J, Budts W, Campens L, Chessa M, Jesús Del Cerro Marin M, Gabriel H, Gallego P, González EA, Jensen AS, Ladouceur M, Lockhart C, Miranda-Barrio B, Morissens M, Escobar EM, Pasquet A, Soriano JR, Elise van den Bosch A, Berdina van der Zwaan H, Tobler D, Greutmann M, Schwerzmann M. The coronavirus disease pandemic among adult congenital heart disease patients and the lessons learnt - results of a prospective multicenter european registry. Int J Cardiol Congenit Heart Dis 2023; 11:100428. [PMID: 36440468 PMCID: PMC9678209 DOI: 10.1016/j.ijcchd.2022.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background At the beginning of the COVID-19 pandemic, professionals in charge of particularly vulnerable populations, such as adult congenital heart disease (ACHD) patients, were confronted with difficult decision-making. We aimed to assess changes in risk stratification and outcomes of ACHD patients suffering from COVID-19 between March 2020 and April 2021. Methods and results Risk stratification among ACHD experts (before and after the first outcome data were available) was assessed by means of questionnaires. In addition, COVID-19 cases and the corresponding patient characteristics were recorded among participating centres. Predictors for the outcome of interest (complicated disease course) were assessed by means of multivariable logistic regression models calculated with cluster-robust standard errors. When assessing the importance of general and ACHD specific risk factors for a complicated disease course, their overall importance and the corresponding risk perception among ACHD experts decreased over time. Overall, 638 patients (n = 168 during the first wave and n = 470 during the subsequent waves) were included (median age 34 years, 52% women). Main independent predictors for a complicated disease course were male sex, increasing age, a BMI >25 kg/m2, having ≥2 comorbidities, suffering from a cyanotic heart disease or having suffered COVID-19 in the first wave vs. subsequent waves. Conclusions Apart from cyanotic heart disease, general risk factors for poor outcome in case of COVID-19 reported in the general population are equally important among ACHD patients. Risk perception among ACHD experts decreased during the course of the pandemic.
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Affiliation(s)
- Francisco Javier Ruperti-Repilado
- Centre for Congenital Heart Disease, Cardiology, University Hospital Inselspital, University of Bern, Switzerland
- Division of Cardiology, University Hospital of Basel, University of Basel, Switzerland
| | - Helmut Baumgartner
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Germany
| | - Berto Bouma
- Department of Cardiology, Academic Medical Centre, Amsterdam, Netherlands
| | - Judith Bouchardy
- Department of Cardiology and Cardiac Surgery, University Hospital Lausanne, Lausanne, Switzerland
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Belgium
| | - Laurence Campens
- Cardiology Department, Ghent University Hospital, Ghent, Belgium
| | - Massimo Chessa
- ACHD-Unit. Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milanese, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | | | - Harald Gabriel
- Medical University of Vienna, Department of Cardiology, Adult Congenital Heart Disease Program, Vienna, Austria
| | - Pastora Gallego
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario, Virgen Del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Sevilla, Spain
| | | | | | - Magalie Ladouceur
- Université de Paris, Hôpital Européen Georges Pompidou, AP-HP, Adult Congenital Heart Disease Unit, Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C. Inserm U970, Paris Centre de Recherche Cardiovasculaire, Paris, France
| | - Christopher Lockhart
- Department of Cardiology, Belfast Health and Social Care Trust, BT126BA, United Kingdom
| | - Berta Miranda-Barrio
- Unitat Integrada de Cardiopaties Congènites de L'Adolescent I L'Adult Hospital Vall D'Hebron-Sant Pau. Servei de Cardiologia. Vall D'Hebron Hospital Universitari, Vall D'Hebron Barcelona Hospital Campus, Passeig Vall D'Hebron 119-129, 08035, Barcelona, Spain
| | | | - Eduardo Moreno Escobar
- Inter-Center Unit for Congenital Heart Disease in Adults of Granada. Virgen de Las Nieves-Clínico San Cecilio University Hospitals. IBS, Granada, Spain
| | - Agnès Pasquet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joaquin Rueda Soriano
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitari I Politècnic La Fe and CIBERCV, València, Spain
| | | | | | - Daniel Tobler
- Division of Cardiology, University Hospital of Basel, University of Basel, Switzerland
| | - Matthias Greutmann
- University Heart Centre, Department of Cardiology, University of Zurich, Switzerland
| | - Markus Schwerzmann
- Centre for Congenital Heart Disease, Cardiology, University Hospital Inselspital, University of Bern, Switzerland
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Schwerzmann M, Ruperti-Repilado FJ, Baumgartner H, Bouma B, Bouchardy J, Budts W, Campens L, Chessa M, Del Cerro Marin MJ, Gabriel H, Gallego P, Garcia-Orta R, Gonzalez AE, Jensen AS, Ladouceur M, Miranda-Barrio B, Morissens M, Pasquet A, Rueda J, van den Bosch AE, van der Zwaan HB, Tobler D, Greutmann M. Clinical outcome of COVID-19 in patients with adult congenital heart disease. Heart 2021; 107:1226-1232. [PMID: 33685931 PMCID: PMC7944416 DOI: 10.1136/heartjnl-2020-318467] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS Patients with adult congenital heart disease (ACHD) are a potentially vulnerable patient cohort in case of COVID-19. Some cardiac defects may be associated with a poor COVID-19 outcome. Risk estimation in ACHD is currently based on expert opinion. The aim of this study was to collect clinical outcome data and to identify risk factors for a complicated course of COVID-19 in patients with ACHD. METHODS Twenty-five ACHD centres in nine European countries participated in the study. Consecutive patients with ACHD diagnosed with COVID-19 presenting to one of the participating centres between 27 March and 6 June 2020 were included. A complicated disease course was defined as hospitalisation for COVID-19 requiring non-invasive or invasive ventilation and/or inotropic support, or a fatal outcome. RESULTS Of 105 patients with a mean age of 38±13 years (58% women), 13 had a complicated disease course, of whom 5 died. In univariable analysis, age (OR 1.3, 95% CI 1.1 to 1.7, per 5 years), ≥2 comorbidities (OR 7.1, 95% CI 2.1 to 24.5), body mass index of >25 kg/m2 (OR 7.2, 95% CI 1.9 to 28.3) and cyanotic heart disease (OR 13.2, 95% CI 2.5 to 68.4) were associated with a complicated disease course. In a multivariable logistic regression model, cyanotic heart disease was the most important predictor (OR 60.0, 95% CI 7.6 to 474.0). CONCLUSIONS Among patients with ACHD, general risk factors (age, obesity and multiple comorbidities) are associated with an increased risk of complicated COVID-19 course. Congenital cardiac defects at particularly high risk were cyanotic lesions, including unrepaired cyanotic defects or Eisenmenger syndrome.
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Affiliation(s)
- Markus Schwerzmann
- Center for Congenital Heart Disease, Inselspital University Hospital, Bern, Switzerland
| | | | - Helmut Baumgartner
- Dept. of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Munster, Nordrhein-Westfalen, Germany
| | - Berto Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Judith Bouchardy
- Department of Cardiology and Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Division of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospital Leuven, Leuven, Flanders, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Flanders, Belgium
| | - Laurence Campens
- Department of Cardiology, Ghent University Hospital, Gent, Oost-Vlaanderen, Belgium
| | - Massimo Chessa
- ACHD UNIT - Pediatric and Adult Congenital Heart Centre, IRCCS - Policlinico San Donato, San Donato Milanese - Milan, Lombardia, Italy
| | | | - Harald Gabriel
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Pastora Gallego
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario, Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Sevilla, Spain
| | - Rocio Garcia-Orta
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen de las Nieves. 2 Instituto de Investigación Biosanitaria ibs, Granada, Andalucía, Spain
| | | | | | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Université de Paris, Hôpital Européen Georges Pompidou, AP-H, Paris, France
| | - Berta Miranda-Barrio
- Integrated Adult Congenital Heart Disease Unit, Vall d'Hebron University Hospital and Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | | | - Agnes Pasquet
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Joaquín Rueda
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitari i Politècnic La Fe and CIBERCV, Valencia, Comunidad Valenciana, Spain
| | | | | | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matthias Greutmann
- Departament of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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