Worse Hospital Outcomes for Children and Adults with COVID-19 and Congenital Heart Disease

Abstract

The aim of the current study is to investigate hospitalization outcomes of COVID-19 positive children and adults with moderate or severe congenital heart disease to children and adults without congenital heart disease. Retrospective review using the Vizient Clinical Data Base for admissions of patients with an ICD-10 code for COVID-19 from April 2020 to March 2021. Admissions with COVID-19 and with and without moderate or severe congenital heart disease (CHD) were stratified into pediatric (< 18 years) and adult (≥ 18 years) and hospital outcomes were compared. There were 9478 pediatric COVID-19 admissions, 160 (1.7%) with CHD, and 658,230 adult COVID-19 admissions, 389 (0.06%) with CHD. Pediatric admissions with COVID-19 and CHD were younger (1 vs 11 years), had longer length of stay (22 vs 6 days), higher complication rates (6.9 vs 1.1%), higher mortality rates (3.8, 0.8%), and higher costs ($54,619 vs 10,731; p < 0.001 for all). Adult admissions with COVID-19 and CHD were younger (53 vs 64 years, p < 0.001), had longer length of stay (12 vs 9 days, p < 0.001), higher complication rates (8 vs 4.8%, p = 0.003), and higher costs ($23,551 vs 13,311, p < 0.001). This appears to be the first study to report the increased hospital morbidities and costs for patients with CHD affected by COVID-19. Our hope is that these findings will help counsel patients moving forward during the pandemic.

The Lethality of COVID-19 for Children with Congenital Heart Disease

“…A very interesting observation in the present study is that there was no increment in mortality among adult CHD patients compared to non-CHD [1]. Maybe CHD acts canceling the protective effect childhood demonstrated in COVID-19 disease [4].…”

“…To the Editor, We welcome and read with great interest the article "Worse Hospital Outcomes for Children and Adults with COVID-19 and Congenital Heart Disease" by Strah et al [1]. The authors retrospectively analyzed (April 2020-March 2021) 160 children with congenital heart disease (CHD) hospitalized with COVID-19, who accounted for 1.7% of the total admissions for COVID-19 in the Vizient Clinical Data Base and compared with other children with COVID-19 without CHD.…”

COVID-19 and the Vasculature: Current Aspects and Long-Term Consequences

“…Another group of patients prone to get severe COVID-19 are patients with congenital heart disease (CHD) ( Lewis et al, 2020 ; Zareef et al, 2020 ; Haiduc et al, 2021 ; Strah et al, 2021 ). CHD represents one of the most common developmental defects, affecting nearly 1 in 100 newborns and 90% of these patients present with isolated cardiac defects.…”

“…CHD represents one of the most common developmental defects, affecting nearly 1 in 100 newborns and 90% of these patients present with isolated cardiac defects. Notably, although complicated COVID-19 courses are more common in CHD patients, the mortality risk seems not to be significantly affected in adults with CHD and COVID-19 ( Strah et al, 2021 ). In pediatric patients, Down syndrome with common atrioventricular canal is the most described CHD correlating with more severe COVID-19.…”

“…In pediatric patients, Down syndrome with common atrioventricular canal is the most described CHD correlating with more severe COVID-19. However, mortality appears to be only increased in patients with aortic stenosis and complex CHD-like hypoplastic left heart syndrome ( Strah et al, 2021 ). In general, larger cohort studies and more in-depth careful evaluations are required to better define subgroups within CHD patients carrying a higher risk of COVID-19 associated mortality.…”