Risk stratification of adults with congenital heart disease during the COVID-19 pandemic: insights from a multinational survey among European experts
Markus Schwerzmann,
Marielle Morissens,
Matthias Greutmann,
Pastora Gallego,
Annette Schophuus Jensen,
Massimo Chessa,
Daniel Tobler,
Gerhard Diller,
Laura Dos-Subirà,
Magalie Ladouceur,
Francisco Javier Ruperti-Repilado,
Berto Bouma,
Judith Bouchardy,
Harald Gabriel,
Agnes Pasquet,
Julie De Backer,
Rocío García Orta,
María Elvira,
Rodríguez-Monte Garrido-Lestache,
Elvira Ana González,
Pablo Meras,
Berta Miranda,
Joaquin Rueda Soriano,
Oktay Tutare,
Annemien van den Bosch,
Heleen van der Zwaan
Affiliations
Markus Schwerzmann
1 Center for Congenital Heart Disease, Cardiology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
Marielle Morissens
Department of Cardiology, CHU Brugmann, Brussels, Belgium
Matthias Greutmann
Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, Zurich, Switzerland
Pastora Gallego
8 Adult Congenital Heart Disease Unit, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Virgen del Rocio University Hospital Cardiology and Cardiovascular Surgery Service, Sevilla, Spain
Annette Schophuus Jensen
Massimo Chessa
4 Pediatric Cardiology Department and GUCH Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
Daniel Tobler
University Heart Center, University Hospital Basel, Basel, Switzerland
Gerhard Diller
Laura Dos-Subirà
Adult Congenital Heart Disease Unit, Vall d`Hebron University Hospital, Barcelona, Spain
Magalie Ladouceur
Hôpitaux universitaires de Genève, Genève, Switzerland
Francisco Javier Ruperti-Repilado
1 Center for Congenital Heart Disease, Cardiology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
Berto Bouma
10 Department of Cardiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
Judith Bouchardy
4 Cardiovascular Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
Harald Gabriel
9 Adult Congenital Heart Disease Centre, Medical University of Vienna, Wien, Austria
Agnes Pasquet
Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc Pôle de Recherche Cardiovasculaire (CARD) Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain, Brussels, Belgium
Objective Adults with congenital heart disease (ACHD) may be at a higher risk of a fatal outcome in case of COVID-19. Current risk stratification among these patients relies on personal experience and extrapolation from patients with acquired heart disease. We aimed to provide an expert view on risk stratification while awaiting results from observational studies.Methods This study was an initiative of the EPOCH (European Collaboration for Prospective Outcome Research in Congenital Heart disease). Among nine European countries (Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain and Switzerland), 24 experts from 23 tertiary ACHD centres participated in the survey. ACHD experts were asked to identify ACHD-specific COVID-19 risk factors from a list of potential outcome predictors and to estimate the risk of adverse COVID-19 outcomes in seven commonly seen patient scenarios.Results 82% of participants did not consider all ACHD patients at risk of COVID-19 related complications. There was a consensus on pulmonary arterial hypertension, Fontan physiology and cyanotic heart disease as risk factors for adverse outcomes. Among different ACHD scenarios, a patient with Eisenmenger syndrome was considered to be at the highest risk. There was a marked variability in risk estimation among the other potential outcome predictors and ACHD scenarios.Conclusions Pulmonary arterial hypertension, Fontan palliation and cyanotic heart disease were widely considered as risk factors for poor outcome in COVID-19. However, there was a marked disparity in risk estimation for other clinical scenarios. We are in urgent need of outcome studies in ACHD suffering from COVID-19.
