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      COVID-19 in Adults With Congenital Heart Disease

      research-article
      , MD, MCR a , , PhD a , , BS b , , MD c , , MD, MPH c , , MD d , , MD d , , MD e , , NP e , , MD f , , MD f , , MD g , , BS g , , MD h , , BS h , , MD i , , MD i , , MD, PhD j , , MD k , , MD l , , MD, PhD m , , MD n , , MD, MHS o , , MD p , , MD q , , MD, PhD r , , MD s , , MD t , , MD u , , MD v , , MD, PhD w , , MD x , , MD y , , MD z , , MD aa , , MD bb , , MD, MSc cc , , MD, MSc dd , , MD ee , , MD ff , , MD gg , , MD hh , , MD ii , , MD jj , , MD kk , , MD ll , , MD mm , , NP nn , , MD oo , , MD pp , , MD, PhD qq , , MD rr , , MD ss , , MD tt , , MD uu , , MD vv , , MD ww , , MD, PhD xx , , MD yy , , MD zz , , MD, MPH aaa , , MD bbb , , MD ccc , , MD ddd , , MD eee , , MD fff , , MD ggg , , MD hhh , , MD b ,
      Journal of the American College of Cardiology
      by the American College of Cardiology Foundation. Published by Elsevier.
      adult congenital heart disease, coronavirus, COVID-19, hospitalization, CHD, congenital heart disease, CI, confidence interval, COVID-19, coronavirus disease-2019, eGFR, estimated glomerular filtration rate, ICU, intensive care unit, OR, odds ratio, PAH, pulmonary arterial hypertension, PCR, polymerase chain reaction

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          Abstract

          Background

          Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications.

          Objectives

          This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes.

          Methods

          Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined.

          Results

          From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not.

          Conclusions

          COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.

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          Most cited references35

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          6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

          Background The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity. Methods We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5–6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences. Findings In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0–65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0–199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5–6, and median CT scores were 3·0 (IQR 2·0–5·0) for severity scale 3, 4·0 (3·0–5·0) for scale 4, and 5·0 (4·0–6·0) for scale 5–6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80–3·25) for scale 4 versus scale 3 and 4·60 (1·85–11·48) for scale 5–6 versus scale 3 for diffusion impairment; OR 0·88 (0·66–1·17) for scale 4 versus scale 3 and OR 1·77 (1·05–2·97) for scale 5–6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58–0·96) for scale 4 versus scale 3 and 2·69 (1·46–4·96) for scale 5–6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up. Interpretation At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery. Funding National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, and Peking Union Medical College Foundation.
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            Is Open Access

            Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study

            Abstract Objective To characterise the clinical features of patients admitted to hospital with coronavirus disease 2019 (covid-19) in the United Kingdom during the growth phase of the first wave of this outbreak who were enrolled in the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO) Clinical Characterisation Protocol UK (CCP-UK) study, and to explore risk factors associated with mortality in hospital. Design Prospective observational cohort study with rapid data gathering and near real time analysis. Setting 208 acute care hospitals in England, Wales, and Scotland between 6 February and 19 April 2020. A case report form developed by ISARIC and WHO was used to collect clinical data. A minimal follow-up time of two weeks (to 3 May 2020) allowed most patients to complete their hospital admission. Participants 20 133 hospital inpatients with covid-19. Main outcome measures Admission to critical care (high dependency unit or intensive care unit) and mortality in hospital. Results The median age of patients admitted to hospital with covid-19, or with a diagnosis of covid-19 made in hospital, was 73 years (interquartile range 58-82, range 0-104). More men were admitted than women (men 60%, n=12 068; women 40%, n=8065). The median duration of symptoms before admission was 4 days (interquartile range 1-8). The commonest comorbidities were chronic cardiac disease (31%, 5469/17 702), uncomplicated diabetes (21%, 3650/17 599), non-asthmatic chronic pulmonary disease (18%, 3128/17 634), and chronic kidney disease (16%, 2830/17 506); 23% (4161/18 525) had no reported major comorbidity. Overall, 41% (8199/20 133) of patients were discharged alive, 26% (5165/20 133) died, and 34% (6769/20 133) continued to receive care at the reporting date. 17% (3001/18 183) required admission to high dependency or intensive care units; of these, 28% (826/3001) were discharged alive, 32% (958/3001) died, and 41% (1217/3001) continued to receive care at the reporting date. Of those receiving mechanical ventilation, 17% (276/1658) were discharged alive, 37% (618/1658) died, and 46% (764/1658) remained in hospital. Increasing age, male sex, and comorbidities including chronic cardiac disease, non-asthmatic chronic pulmonary disease, chronic kidney disease, liver disease and obesity were associated with higher mortality in hospital. Conclusions ISARIC WHO CCP-UK is a large prospective cohort study of patients in hospital with covid-19. The study continues to enrol at the time of this report. In study participants, mortality was high, independent risk factors were increasing age, male sex, and chronic comorbidity, including obesity. This study has shown the importance of pandemic preparedness and the need to maintain readiness to launch research studies in response to outbreaks. Study registration ISRCTN66726260.
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              Potential Effects of Coronaviruses on the Cardiovascular System: A Review

              Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) has reached a pandemic level. Coronaviruses are known to affect the cardiovascular system. We review the basics of coronaviruses, with a focus on COVID-19, along with their effects on the cardiovascular system.
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                Author and article information

                Journal
                J Am Coll Cardiol
                J Am Coll Cardiol
                Journal of the American College of Cardiology
                by the American College of Cardiology Foundation. Published by Elsevier.
                0735-1097
                1558-3597
                29 March 2021
                6 April 2021
                29 March 2021
                : 77
                : 13
                : 1644-1655
                Affiliations
                [a ]Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
                [b ]Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA
                [c ]Division of Cardiology, Columbia University Medical Center, New York, New York, USA
                [d ]Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
                [e ]Division of Cardiology, York University Langone Health, New York, New York, USA
                [f ]Instituto Nacional del Tórax - Pontificia Universidad Católica de Chile, Santiago, Chile
                [g ]Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
                [h ]Division of Cardiology, University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa, USA
                [i ]Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
                [j ]Second Cardiology Department, ATTIKON University Hospital, Athens, Greece
                [k ]Shaare Zedek Medical Center, Jerusalem, Israel
                [l ]Penn State Hershey Heart and Vascular Institute, State College, Pennsylvania, USA
                [m ]Division of Cardiology, Children’s National Hospital, Washington, DC, USA
                [n ]McMaster University, Hamilton, Ontario, Canada
                [o ]UPMC Adult Congenital Heart Disease Program, Pittsburgh, Pennsylvania, USA
                [p ]Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
                [q ]University of Tennessee Health Science Center, Le Bonheur Heart Institute, Memphis, Tennessee, USA
                [r ]Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
                [s ]Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
                [t ]Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
                [u ]Division of Cardiology, University Hospital of Basel, Basel, Switzerland
                [v ]Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
                [w ]Cardiology Service, Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
                [x ]Anschutz Medical Campus, Colorado’s Adult and Teen Congenital Heart Program, Aurora, Colorado, USA
                [y ]Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
                [z ]Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
                [aa ]Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
                [bb ]Division of Cardiovascular Medicine and Pediatric Cardiology, Stanford University School of Medicine, Stanford, California, USA
                [cc ]Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA
                [dd ]Weill Cornell Medicine, New York Presbyterian Hospital, Department of Medicine and Pediatrics, New York, New York, USA
                [ee ]Cincinnati Children’s Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
                [ff ]Department of Pediatrics and Medicine, University of Wisconsin, Madison, Wisconsin, USA
                [gg ]Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, USA
                [hh ]University of British Columbia, St. Paul’s Hospital, Vancouver, British Colombia, Canada
                [ii ]Providence Adult and Teen Congenital Heart Program, Pediatric and Adult Cardiology, Spokane, Washington, USA
                [jj ]Department of Pediatric and Adult Congenital Heart Disease, Somer Incare Cardiovascular Center, Rionegro, Colombia
                [kk ]Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
                [ll ]Department of Cardiology and Cardiac Surgery, University Hospital Lausanne, Lausanne, Switzerland
                [mm ]Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
                [nn ]OSF Healthcare Children’s Hospital of Illinois, Adult Congenital Heart Program, Peoria, Illinois, USA
                [oo ]Department of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
                [pp ]Division of Cardiology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
                [qq ]Hôpital Européen Georges Pompidou, Adult Congenital Heart Disease Unit, Paris, France
                [rr ]University Hospital Inselspital, Center for Congenital Heart Disease, Bern, Switzerland
                [ss ]Department of Cardiology, University of Zurich, Zurich, Switzerland
                [tt ]University Hospital La Paz, Madrid, Spain
                [uu ]ASST Papa Giovanni XXIII, Cardiovascular Department, University of Milano, Bergamo, Italy
                [vv ]Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
                [ww ]University of Texas at Houston, Adult Congenital Heart Disease, Houston, Texas, USA
                [xx ]Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
                [yy ]Cedars-Sinai Medical Center, The Geurin Family Congenital Heart Program, Los Angeles, California, USA
                [zz ]West Virginia University, Adult Congenital Heart Disease Program, Morgantown, West Virginia, USA
                [aaa ]Medical College of Wisconsin, Adult Congenital Heart Disease Program, Milwaukee, Wisconsin, USA
                [bbb ]Division of Cardiology, University of Arizona, Tucson, Arizona, USA
                [ccc ]Hôpital Marie Lannelongue, Le Plessis Robinson, France
                [ddd ]Tehran University of Medical Sciences, Tehran, Iran
                [eee ]Connecticut Children’s Medical Center, Pediatric Cardiology Hartford, Connecticut, USA
                [fff ]Department of Medicine and Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
                [ggg ]Helen DeVos Children’s Hospital, Adult Congenital Heart Center, Grand Rapids, Michigan, USA
                [hhh ]Department of Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
                Author notes
                [] Address for correspondence: Dr. Jamil A. Aboulhosn, UCLA Adult Congenital Heart Center, 100 UCLA Medical Plaza, Suite 630, East Los Angeles, California 90095, USA.
                Article
                S0735-1097(21)00397-1
                10.1016/j.jacc.2021.02.023
                8006800
                33795039
                c11648fc-221e-49b9-a891-aab32e1f35f3
                © 2021 by the American College of Cardiology Foundation. Published by Elsevier.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 17 December 2020
                : 1 February 2021
                : 8 February 2021
                Categories
                Original Investigation

                Cardiovascular Medicine
                adult congenital heart disease,coronavirus,covid-19,hospitalization,chd, congenital heart disease,ci, confidence interval,covid-19, coronavirus disease-2019,egfr, estimated glomerular filtration rate,icu, intensive care unit,or, odds ratio,pah, pulmonary arterial hypertension,pcr, polymerase chain reaction

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