Introduction: In March 2020, no evidence on outcomes among adults with congenital heart disease (ACHD) with the Coronavirus Disease 2019 (COVID-19) was available.
Material and Methods: We collected reported COVID-19 cases among ACHD patients followed at 26 tertiary care centers in 10 European countries between March 27, 2020 and March 25, 2021. Information related to demographics, COVID-19 course, heart defect and medical history were recorded. Cases were stratified into first vs. subsequent COVID-19 waves (cut-off date July 15, 2020). A complicated disease course was defined as hospitalization for COVID-19 requiring ventilation and/or inotropic support, extracorporeal membrane oxygenation or death.
Results: We included 548 cases (first wave: n=161; subsequent waves: n=387). Median age was 33 (26-44) years, and 52% were female. Thirty-three (6%) patients had a complicated disease course. Between waves (first vs. subsequent), there were no statistically significant differences related to gender (women 57% vs. 49%, p=0.09), body mass index (BMI) category (p=0.7), heart defect complexity (p=0.08) and residual heart defect-related problems (p=0.6). Patients in the first wave were older, had more often ≥ 2 comorbidities and a complicated disease course (37 vs 33 years, p=0,001; 17% vs. 7%, p=0.0003; and 9% vs. 5%, p=0.04, respectively). However, deaths were rather equally distributed (4% vs 2%, p=0.2) between waves. From multivariable models, adjusted odds ratios for the prediction of complicated COVID-19 course are depicted in the table.
Conclusion: Complicated COVID-19 course among ACHD patients is rare. Outcomes in the first wave were significantly worse when compared to subsequent waves, mainly because patients of the first wave were older and had more comorbidities. Age, cyanotic heart disease, having ≥ 2 comorbidities and a BMI >25 kg/m2 were the main predictors for a complicated disease course.
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