Congenital Heart Defects a Risk Factor for Critical Illness From COVID-19

Healthcare workers intubating a COVID patient
Hospital COVID Healthcare workers during an intubation procedure to a COVID patient
Researchers examined characteristics associated with critical COVID-19 illness among patients with congenital heart defects.

Among patients with a congenital heart defect (CHD) who are hospitalized with COVID-19, older age, male sex, and the presence of comorbidities all were associated with a higher adjusted prevalence for critical COVID-19 illness. These findings were published in the journal Circulation.

Data on inpatient encounters between March 2020 and January 2021, derived from the Premier Healthcare Database Special COVID-19 Release—an all-payor database that represents approximately 20% of US hospital admissions—were used to compare the period prevalence of critical COVID-19 illness (ie, intensive care unit [ICU] admission, use of invasive mechanical ventilation, or death) among hospitalized patients with COVID-19 with and without CHDs.

In this study, ICU admission, use of invasive mechanical ventilation, and death were defined as 1 or more inpatient codes for the stated outcome during hospitalization following COVID-19 diagnosis. Additional characteristics included other known comorbidities (≥1 inpatient diagnosis of pulmonary hypertension [PH], heart failure [HF], Down syndrome, type 1 or type 2 diabetes, or obesity); sex; age group; race and ethnicity; hospital urbanicity; and payor type.

In patients hospitalized with COVID-19, critical outcomes and characteristics were evaluated according to CHD status. Adjusted prevalence ratios (aPRs) and 95% CIs were measured for each outcome that compared patients with and without CHDs, adjusted according to sex, age group, race and ethnicity, and payor type. In those with both

COVID-19 and CHD, critical COVID-19 outcomes were evaluated with the use of crude prevalence ratios (cPRs).

Among a total of 235,638 hospitalized patients, aged 1 to 64 years, with COVID-19, 0.2% had a CHD. This was consistent with CHD prevalence in non-COVID-19-related health care data sets. Overall, 68.4% of individuals with CHD and 58.8% of those without CHD had 1 or more comorbidity. Regarding age, 12.8% of patients with CHDs and 1.4% of those without CHDs were aged between 1 and 17 years.

Further, 53.9% of patients with CHDs were admitted to the ICU, 24.0% required the use of invasive mechanical ventilation, and 11.2% died during hospitalization. Following adjustment, ICU admission, invasive mechanical ventilation, and death all were more prevalent among patients with COVID-19 and a CHD compared with patients with COVID-19 without CHDs (aPRs, 1.4, 1.8, and 2.0, respectively). After stratification by high-risk characteristics, prevalence estimates for ICU admissions, use of invasive mechanical ventilation, and death remained higher in patients with COVID-19 and a CHD than among those with COVID-19 without CHDs across almost all strata, including younger age group, HF, PH, Down syndrome, obesity, or diabetes.

In the 421 patients with CHDs, critical COVID-19 outcomes were all significantly associated with the presence of comorbidities (1 comorbidity: invasive mechanical ventilation, cPR=2.5; ≥2 comorbidities: ICU, cPR=1.3; invasive mechanical ventilation, cPR=3.3; death, cPR=4.0), male sex (ICU, cPR=1.3), and aged 50 to 64 years vs 18 to 29 years (invasive mechanical ventilation, cPR=3.0; data not shown; P <.05 for all).

This analysis is the first to include a comparison group with COVID-19 without CHDs, as well as to adjust the study findings according to differences in age, sex, race and ethnicity, comorbidities, location, and payor type.

“Targeted strategies to increase awareness of CHD as a risk factor for critical COVID-19 illness and emphasize the critical importance of prevention of COVID-19 illness for people with CHD and their families through vaccination, masking, and physical distancing are needed,” the study authors concluded.

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  


Downing KF, Simeone RM, Oster ME, Farr SL. Critical illness among patients hospitalized with acute COVID-19 with and without congenital heart defects. Circulation. Published online March 7, 2022. doi:10.1161/CIRCULATIONAHA.121.057833