29 abril, 2022

Does COVID-19 Affect Adults With Heart Defects More Seriously?

Clinical Context

Several clinical factors, including heart disease, increase risk for severe COVID-19 illness. The association of congenital heart defects (CHDs) with such risk among adults is unclear. A recent study which analyzed data from patients hospitalized with COVID-19 compared those with and without CHDs to provide additional evidence to support COVID-19 mitigation strategies such as social distancing and vaccinations. This study also identified the need for further studies that factor in social, economic, and other disparities that may influence COVID-19 outcomes for patients with CHDs. Additionally, more data is still needed for the role of specific comorbidities in severe COVID-19 illness to help guide members of the healthcare team when caring for the most critically ill and vulnerable patients.

Study Synopsis and Perspective

Adults with CHDs are at increased risk for serious illness and death when hospitalized with COVID-19, making vaccination and other preventive measures even important in this population, said researchers with the Centers for Disease Control and Prevention (CDC).

“We found that hospitalized patients with heart defects are up to twice as likely to have critical outcomes of COVID-19 illness (admission to the intensive care unit [ICU], use of a ventilator to help with breathing, or death) compared to hospitalized COVID-19 patients without heart defects,” Karrie Downing, MPH, epidemiologist, with the CDC’s National Center on Birth Defects and Developmental Disabilities, told theheart.org | Medscape Cardiology.

“Additionally, we learned that people with hearts defects who were older or who also had other conditions like heart failure, pulmonary hypertension, Down syndrome, diabetes, or obesity were the most likely to have critical COVID-19 illness, but children and adults with heart defects without these other conditions were still at increased risk,” Downing said.

The message for healthcare providers is clear: “Encourage your patients with heart defects to get vaccinated and discuss with your patients the need for other preventive measures to avoid infection that may progress to severe COVID-19 illness,” Downing added.

The study was published online March 7 in Circulation.

The researchers analyzed data on 235,638 patients hospitalized with COVID-19 between March 2020 and January 2021, including 421 (0.2%) with CHDs.

Most patients with CHDs were aged 30 years or older (73%), and 61% were men, with 55% non-Hispanic White, 20% Hispanic, and 16% non-Hispanic Black.

Overall, 68% of patients with CHDs had at least 1 comorbidity, as did 59% of patients without CHDs.

Rates of ICU admission were higher in the CHD group (54% vs 43%), as were rates of invasive mechanical ventilation (IMV) (24% vs 15%) and in-hospital death (11% vs 7%).

After accounting for patient characteristics, ICU admission, IMV, and death were more prevalent among patients with COVID-19 with rather than without CHDs, with adjusted prevalence ratios (aPRs) of 1.4, 1.8 and 2, respectively.

When stratified by high-risk characteristics, prevalence estimates for ICU admission, IMV, and death remained higher among patients with COVID-19 and CHDs across nearly all strata, including younger age groups and persons without heart failure, pulmonary hypertension, Down syndrome, diabetes, or obesity, the researchers reported.

Downing said more work is needed to identify why the clinical course of COVID-19 disease results in admission to the ICU, the need for a ventilator, or death for some hospitalized patients with CHDs and not for others.

“There could be a number of social, environmental, economic, medical, and genetic factors playing a role. But staying up to date with COVID-19 vaccines and following preventive measures for COVID-19 are effective ways to reduce the risk of severe illness from COVID-19,” Downing said.

The study had no specific funding. The authors report no relevant disclosures.

Circulation.Published online March 7, 2022.^[1]

Study Highlights

This analysis included all 1- to 64-year-old patients with COVID-19 from March to April 2020 in the Premier Healthcare Database Special COVID-19 Release.
Inpatient ICD-10-CM codes identified CHDs and categorized them by anatomic complexity using a published algorithm.
ICU admission, IMV, and death were defined as ≥ 1 inpatient code for the outcome in the same encounter as the COVID-19 diagnosis.
Other characteristics studied included other known comorbidities (pulmonary hypertension, heart failure, Down syndrome, type 1 or 2 diabetes, or obesity), age group, sex, race/ethnicity, payor type, and hospital urbanicity.
Of 235,638 hospitalized patients with COVID-19 aged 1 to 64 years, 421 (0.2%) had CHDs (consistent with CHD prevalence in non–COVID-19–related healthcare data sets).
73.2% of patients with CHD were aged ≥ 30 years; 60.6% were men; 55.3% were non-Hispanic White, 19.5% Hispanic, and 16.4% non-Hispanic Black.
Overall, 68.4% with and 58.8% without CHDs had ≥ 1 comorbidity; 12.8% vs 1.4%, respectively, were aged 1 to 17 years.
Compared with patients without CHDs, patients with CHDs had higher ICU admission rates (53.9% vs 42.6%), IMV rates (24% vs 14.5%) and in-hospital deaths (11.2% vs 6.9%).
After adjustment for age group, sex, race/ethnicity, and payor type, patients with vs without CHDs had more prevalent ICU admission (aPR = 1.4), IMV (aPR = 1.8), and death (aPR = 2).
When stratified by high-risk characteristics, aPRs for ICU admissions, IMV, and death remained higher among patients with vs without CHDs across nearly all strata, including younger age groups and individuals without heart failure, pulmonary hypertension, Down syndrome, diabetes, or obesity.
Among the 421 patients with CHDs, critical COVID-19 outcomes were associated with comorbidities (1 comorbidity: IMV [crude prevalence ratio (cPR) = 2.5]; ≥ 2 comorbidities: ICU [cPR = 1.3], IMV [cPR = 3.3], death [cPR = 4]); male sex (ICU [cPR = 1.3); and age 50 to 64 vs 18 to 29 years (IMV [cPR = 3]); all P < .05.
The investigators concluded that after adjustment for and stratification by known high-risk factors for severe COVID-19, prevalence of critical COVID-19 was up to twice as high among patients with CHDs.
Findings were similar among younger patients and patients without comorbidities.
Although the frequency of critical COVID-19 illness among patients with CHDs was similar in this and previous studies, the latter concluded that outcomes among patients with CHDs were no different from those of the general population.
Still, these had no comparison group without CHDs and did not adjust for differences in age, comorbidities, race/ethnicity, sex, payor type, or location.
Among patients hospitalized with COVID-19 with CHDs, comorbidities, older age, and male sex were associated with higher aPR for critical COVID-19.
The findings mandate targeted strategies to raise awareness of CHDs as a risk factor for critical COVID-19 illness and highlight the critical importance of COVID-19 illness prevention for people with CHDs and their families by vaccination, masking, and physical distancing.
More research is needed to determine why the clinical course of COVID-19 leads to ICU admission, IMV, or death for some hospitalized patients with CHDs and not others.
Possible explanations could include social, environmental, economic, medical, and genetic factors.
Study limitations include lack of generalizability to patients who were not hospitalized.

Clinical Implications

After adjustment for and stratification by known high-risk factors for severe COVID-19, prevalence of critical COVID-19 was up to twice as high among patients with CHDs.
Among patients hospitalized with COVID-19 with CHDs, comorbidities, older age, and male sex were associated with higher aPR for critical COVID-19.
Implications for the Healthcare Team: The findings mandate targeted strategies to raise awareness of CHDs as a risk factor for critical COVID-19 illness and highlight the critical importance of COVID-19 illness prevention for people with CHDs and their families by vaccination, masking, and physical distancing.

https://www.medscape.org/viewarticle/971922?src=soc_fb_220425_mscpedu_cme_tho_covidheartdefect&faf=1

Créditos: Comité científico Covid