Study: Congenital Heart Defects May Not Increase Risk of Severe COVID-19

Rather than having an intrinsically lower risk of severe COVID-19, the patients in the study may have adhered more strictly to social distancing guidelines compared to the general population.

Contrary to concerns early in the pandemic, a new study found that adults and children born with heart defects had lower than expected risks of developing moderate or severe coronavirus disease 2019 (COVID-19) symptoms, according to a study conducted by Columbia University Irving Medical Center.

Multiple studies have found that individuals with heart disease have a higher risk of life-threatening illness and complications from COVID-19, although the impact of the disease on individuals with congenital heart defects was unknown. According to the study, approximately 1% of infants born each year in the United States have 1 or more heart defects.

“At the beginning of the pandemic, many feared that congenital heart disease would be as big a risk factor for severe COVID-19 as adult-onset cardiovascular disease,” said Matthew Lewis, MD, co-leader of the study, in a press release. “We were reassured by the low number of congenital heart patients who required hospitalization for COVID-19 and the relatively good outcomes of these patients.”

The study included more than 7000 patients from the congenital heart disease center at the Columbia University Vagelos College of Physicians and Surgeons. Of those, only 53 patients (43 adults and 10 children) presented to their physician with symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March and June 2020. During the study period, an estimated 20% of people in the New York metropolitan area are thought to have been infected with COVID-19—a significant difference from the less than 0.8% of patients at Columbia’s congenital heart center.

Of the 53 patients, 43 (80%) had mild symptoms. Of the 9 patients who developed moderate to severe symptoms, 3 died. In comparison, another study performed during the same period found that roughly 22% of hospitalized patients from the general population became critically ill and approximately one-third of those patients died.

The current study also found that patients with a genetic syndrome and adults with advanced disease from their congenital heart defect were more likely to develop moderate to severe symptoms, although an individual’s type of congenital heart defect did not affect symptom severity. Although they acknowledged that the study sample was small, the researchers concluded that congenital heart disease alone may not be enough to increase the risk of severe COVID-19 symptoms.

The study authors added, however, that it is unlikely that individuals with congenital heart disease have an intrinsically lower risk of becoming severely ill from COVID-19. They hypothesized that the patients in the study may have adhered more strictly to social distancing guidelines compared to the general population, given the publicity about increased COVID-19 risk in patients with heart disease. In a press release, the researchers cautioned that individuals with congenital heart disease should continue to practice strict social distancing and follow all CDC guidelines.

They also said that the younger average age of these patients and lower incidence of acquired cardiac risk factors compared with others who had severe COVID-19 may explain why fewer congenital heart patients had severe symptoms.

“It’s possible that elderly patients with congenital heart disease might have a different risk profile than the general population,” said Brett Anderson, MD, MS, MBA, co-leader of the study, in a press release. “We have yet to define what those risk factors are.”

REFERENCE

Congenital heart defects may not increase the risk of severe COVID-19 symptoms [news release]. EurekAlert; October 16, 2020. https://www.eurekalert.org/pub_releases/2020-10/cuim-chd101620.php. Accessed January 27, 2021.