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2.
Cardiol Young ; 32(1): 31-35, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1635444

ABSTRACT

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic negatively impacted global healthcare. Consequences in Pediatric and Congenital Heart Surgery programmes and mortality of congenital heart patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) is still to be determined. OBJECTIVE: To study the COVID-19 pandemic implications in Brazilian Pediatric and Congenital Heart Surgery programmes. METHODS: We conducted a national online survey covering all states that perform Pediatric and Congenital Heart Surgery from 10 November to 22 November, 2020, using a Google forms questionnaire. We formulated questions related to impact on surgical volume, case-mix, and mortality. Then we asked about short-term post-operative COVID-19 infection and outcomes. RESULTS: We received responses from 46 centres representing all states where there were a Pediatric and Congenital Heart Surgery programme and all high-volume centres across the country. All but one centre experienced a significant decrease in surgical volume, and 23.9% of the responders revealed less than one-quarter of volume decrement. On the other hand, in over 70% of the centres, there was a significant surgical volume reduction. In addition to this, there was a shift in case-mix in 41 centres (89.1%) towards more complex cases. More than one-third of the responders revealed increased mortality in 2020 compared to previous years, and 43.5% of the programmes (20 centres) had at least one patient contaminated by SARS-Cov-2, accounting for 48 patients. Mortality in post-operative infected patients was 45.8% (22 patients). CONCLUSIONS: In general, Brazilian Pediatric and Congenital Heart Surgery programmes were severely affected by decreased surgical volume, unbalanced case-mix towards more complex cases, and increased mortality. Almost half of the programmes related post-operative COVID-19 contamination with high mortality.


Subject(s)
COVID-19 , Heart Defects, Congenital , Brazil/epidemiology , Child , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Pandemics , SARS-CoV-2
3.
Kardiol Pol ; 80(2): 151-155, 2022.
Article in English | MEDLINE | ID: covidwho-1560764

ABSTRACT

BACKGROUND: It is unclear whether patients with adult congenital heart disease (ACHD) should be considered as an increased risk population with poor outcomes when suffering from COVID-19. AIMS: This study aimed to collect clinical outcome data and to identify risk factors of a complicated course of COVID-19 among ACHD patients. METHODS: Among all outpatients who came to medical attention via telemedicine or direct physician contact at our institution between September 1, 2020 and March 31, 2021, we included all with a COVID-19 diagnosis. The incidence of COVID-19, a clinical course of the disease, and outcome were determined. RESULTS: One hundred and four (8.7%) out of 1 197 patients who were seen at our outpatient clinic for ACHD patients met the definition of COVID-19. Most of them reported a mild course of COVID-19 (99 [95.5%]). Five patients (4.5%) experienced severe symptoms and needed hospitalization. Two patients (1.9% of all with a confirmed diagnosis, 40% with severe infection) died. In the multivariable analysis, decreased systemic ventricular systolic function and any significant valve stenosis were predictors of a complicated disease course. CONCLUSIONS: Our study confirmed previous results showing that a physiology-based model, rather than an anatomy-based model, better predicted COVID-19 outcomes among ACHD patients, which is of importance for patients and healthcare providers during the COVID-19 pandemic.


Subject(s)
COVID-19 , Heart Defects, Congenital , Adult , COVID-19 Testing , Heart Defects, Congenital/complications , Heart Defects, Congenital/epidemiology , Humans , Pandemics , SARS-CoV-2
4.
Pediatr Cardiol ; 43(3): 541-546, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1460299

ABSTRACT

The aim of the current study is to investigate hospitalization outcomes of COVID-19 positive children and adults with moderate or severe congenital heart disease to children and adults without congenital heart disease. Retrospective review using the Vizient Clinical Data Base for admissions of patients with an ICD-10 code for COVID-19 from April 2020 to March 2021. Admissions with COVID-19 and with and without moderate or severe congenital heart disease (CHD) were stratified into pediatric (< 18 years) and adult (≥ 18 years) and hospital outcomes were compared. There were 9478 pediatric COVID-19 admissions, 160 (1.7%) with CHD, and 658,230 adult COVID-19 admissions, 389 (0.06%) with CHD. Pediatric admissions with COVID-19 and CHD were younger (1 vs 11 years), had longer length of stay (22 vs 6 days), higher complication rates (6.9 vs 1.1%), higher mortality rates (3.8, 0.8%), and higher costs ($54,619 vs 10,731; p < 0.001 for all). Adult admissions with COVID-19 and CHD were younger (53 vs 64 years, p < 0.001), had longer length of stay (12 vs 9 days, p < 0.001), higher complication rates (8 vs 4.8%, p = 0.003), and higher costs ($23,551 vs 13,311, p < 0.001). This appears to be the first study to report the increased hospital morbidities and costs for patients with CHD affected by COVID-19. Our hope is that these findings will help counsel patients moving forward during the pandemic.


Subject(s)
COVID-19 , Heart Defects, Congenital , Adult , Child , Heart Defects, Congenital/complications , Heart Defects, Congenital/epidemiology , Hospitalization , Hospitals , Humans , Length of Stay
5.
Int J Environ Res Public Health ; 18(19)2021 Sep 25.
Article in English | MEDLINE | ID: covidwho-1438609

ABSTRACT

Background: The COVID-19 pandemic had a significant impact on the population's ability to be physically active. Purpose: Evaluate the effect of the COVID-19 mitigation measures on exercise tolerance in patients with congenital heart disease (CHD). Materials and methods: All subjects (880, 6-18 years old) who performed a stress test at our hospital from October 2020 to February 2021 and had a similar test one year earlier were enrolled. A questionnaire on the degree of physical activity carried out in 2020 concerning the period prior to the pandemic was compiled. Exercise tolerance and the main anthropometric parameters between the first and second tests were compared. Results: 110 subjects (11.9 ± 4.1 years) were included in the study. The percentage of patients engaged in regular physical activity (RPA) decreased significantly during the pandemic (p < 0.001), and BMI increased significantly (p < 0.001), except among the subjects who began RPA during the lockdown, whereas test duration did not decrease significantly overall but increased in this last subgroup (p < 0.05) Conclusions: The COVID-19 lockdown led to a less active lifestyle with a significant increase in BMI in our group of CHD. These data could have negative effects on the risk profile of this population. RPA practiced at home seems to be effective in counteracting such effects.


Subject(s)
COVID-19 , Heart Defects, Congenital , Adolescent , Child , Communicable Disease Control , Exercise , Heart Defects, Congenital/epidemiology , Humans , Pandemics , SARS-CoV-2 , Sedentary Behavior
6.
J Paediatr Child Health ; 58(3): 468-473, 2022 03.
Article in English | MEDLINE | ID: covidwho-1438040

ABSTRACT

AIM: We aimed to investigate the influenza immunisation status of caregivers and household contacts of children with congenital heart disease (CHD) and potential barriers to vaccine uptake. METHODS: Prospective questionnaire-based survey over two influenza seasons (2019-2020 and 2020-2021) on 161 children with CHD attending a tertiary paediatric cardiology clinic and their families. Logistic regression and factor analysis were performed to identify factors associated with influenza vaccine uptake. RESULTS: Influenza vaccination coverage of children was 65%, whereas that of their fathers and mothers was 34% and 26%, respectively. Children with unvaccinated siblings represented 43% and those with unvaccinated adults in the household 79% of our study population. No statistically significant differences were found before and during COVID-19 pandemic on vaccine uptake. Logistic regression analysis showed that higher education level, understanding the risk of contracting the disease and vaccination status of the child determined the vaccination status of parents, regardless of their age, age of their child, severity of CHD, beliefs about vaccine safety and efficacy and risk of transmission if not vaccinated. Factor analysis revealed distinct groups among unvaccinated parents (76.3% of the variation in the responses). CONCLUSIONS: Vaccination coverage of caregivers and household contacts of children with CHD is suboptimal. Influenza vaccination campaigns should take into consideration the specific characteristics of parental groups and target interventions accordingly to increase their vaccine uptake and indirectly protect children with CHD.


Subject(s)
COVID-19 , Heart Defects, Congenital , Influenza Vaccines , Influenza, Human , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Caregivers , Child , Health Knowledge, Attitudes, Practice , Heart Defects, Congenital/epidemiology , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Pandemics , Prospective Studies , SARS-CoV-2 , Vaccination
7.
Can J Cardiol ; 37(9): 1472-1479, 2021 09.
Article in English | MEDLINE | ID: covidwho-1397232

ABSTRACT

BACKGROUND: Influenza vaccination is the most commonly recommended immune prevention strategy. However, data on influenza vaccination in patients with congenital heart disease (CHD) are scarce. In this study, our goals were to: (1) measure vaccination coverage rates (VCRs) for influenza in a large cohort of children, adolescents, and adults with CHD; (2) identify patient characteristics as predictors for vaccination; and (3) investigate the effect of influenza vaccination on hospitalization. METHODS: A nationwide cohort study in Belgium included 16,778 patients, representing 134,782 vaccination years, from the Belgian Congenital Heart Disease Database Combining Administrative and Clinical Data (BELCODAC). Data over 9 vaccination years (2006-2015) were used, and patients were stratified into 5 age cohorts: 6 months to 4 years; 5-17 years; 18-49 years; 50-64 years; and 65 years and older. RESULTS: In the respective age cohorts, the VCR was estimated to be 6.6%, 8.0%, 23.9%, 46.6%, and 72.8%. There was a steep increase in VCRs as of the age of 40 years. Multivariable logistic regression showed that higher anatomical complexity of CHD, older age, presence of genetic syndromes, and previous cardiac interventions were associated with significantly higher VCRs. Among adults, men had lower and pregnant women had higher VCRs. The association between influenza vaccination and all-cause hospitalization was not significant in this study. CONCLUSIONS: The influenza VCR in people with CHD is low, especially in children and adolescents. Older patients, particularly those with complex CHD, are well covered. Our findings should inform vaccination promotion strategies in populations with CHD.


Subject(s)
Heart Defects, Congenital , Influenza Vaccines/therapeutic use , Influenza, Human , Adolescent , Adult , Aged , Belgium/epidemiology , COVID-19 , Child , Child, Preschool , Cohort Studies , Female , Heart Defects, Congenital/epidemiology , Hospitalization/statistics & numerical data , Humans , Infant , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Male , Middle Aged , Pandemics , SARS-CoV-2 , Treatment Outcome , Vaccination Coverage/statistics & numerical data , Young Adult
8.
J Cardiovasc Med (Hagerstown) ; 22(9): 701-705, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1339452

ABSTRACT

The Coronavirus disease 2019 (COVID-19) pandemic has thoroughly and deeply affected the provision of healthcare services worldwide. In order to limit the in-hospital infections and to redistribute the healthcare professionals, cardiac percutaneous intervention in Pediatric and Adult Congenital Heart Disease (ACHD) patients were limited to urgent or emergency ones. The aim of this article is to describe the impact of the COVID-19 pandemic on Pediatric and ACHD cath laboratory activity during the so-called 'hard lockdown' in Italy. Eleven out of 12 Italian institutions with a dedicated Invasive Cardiology Unit in Congenital Heart Disease actively participated in the survey. The interventional cardiology activity was reduced by more than 50% in 6 out of 11 centers. Adolescent and ACHD patients suffered the highest rate of reduction. There was an evident discrepancy in the management of the hard lockdown, irrespective of the number of COVID-19 positive cases registered, with a higher reduction in Southern Italy compared with the most affected regions (Lombardy, Piedmont, Veneto and Emilia Romagna). Although the pandemic was brilliantly addressed in most cases, we recognize the necessity for planning new, and hopefully homogeneous, strategies in order to be prepared for an upcoming new outbreak.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Emergency Medical Services , Heart Defects, Congenital , Infection Control , Risk Management/methods , Adolescent , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/statistics & numerical data , Civil Defense/methods , Civil Defense/trends , Disease Transmission, Infectious/prevention & control , Emergency Medical Services/methods , Emergency Medical Services/statistics & numerical data , Female , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Organizational Innovation , SARS-CoV-2
9.
Curr Probl Cardiol ; 47(1): 100905, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1252631

ABSTRACT

Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-COV2) infection is a rapid evolving pandemic with multiple peaks of outbreak and substantial mortality worldwide. It has been proposed that infants are more vulnerable to SARS-COV-2 infection. On the other hand, children with COVID-19 have generally milder disease compared to infected adults and more often presented with gastrointestinal symptoms compared to respiratory ones. Multisystem inflammatory syndrome in children (MIS-c) is an ominous demonstration of COVID-19 with cardiac involvement and mortality rate <2%. From cardiovascular point of view, wide spectrum of manifestations including subclinical myocardial injury, myocarditis, stress cardiomyopathies, cardiac arrhythmias, pulmonary thromboembolism and thrombus formation in cardiac chambers and vascular bed has been reported in COVID-19 disease. Congenital heart disease (CHD), assumed as the most prevalent form of congenital disease. Advances in medical and surgical treatments for CHD have led to more alive patients with underlying heart disease secondary to congenital defects. These group of pediatric patients are prone to heart failure, arrhythmia and embolic events. In this narrative review, we intended to evaluate the cardiovascular and pediatric presentations of COVID-19 as well as the manifestation and outcomes of SARS-CoV-2 infection on pediatric patients with CHD.


Subject(s)
COVID-19 , Heart Defects, Congenital , Adult , COVID-19/complications , Child , Heart Defects, Congenital/complications , Heart Defects, Congenital/epidemiology , Humans , Infant , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
10.
Semin Cardiothorac Vasc Anesth ; 25(2): 107-119, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1231220

ABSTRACT

This review focuses on the literature published during the calendar year 2020 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Five major themes are discussed, including COVID-19 in children with heart disease, race and outcome disparities in congenital heart disease, Norwood procedure and outcomes, Fontan procedure and outcomes, and neurotoxicity/neurologic outcomes. A total of 59 peer-reviewed articles are discussed.


Subject(s)
Anesthesia/methods , COVID-19/complications , Heart Defects, Congenital/surgery , Adult , COVID-19/physiopathology , Child , Fontan Procedure , Health Status Disparities , Heart Defects, Congenital/epidemiology , Humans , Norwood Procedures
11.
J Cardiovasc Med (Hagerstown) ; 22(9): 706-710, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1197501

ABSTRACT

AIM: To summarize our experience on the implementation of a telemedicine service dedicated to adult congenital heart disease (ACHD) patients during the lockdown for the first wave of Coronavirus disease 2019 (COVID-19). METHODS: This is a prospective study enrolling all ACHD patients who answered a questionnaire dedicated telematic cardiovascular examination. RESULTS: A total of 289 patients were enrolled, 133 (47%) were male, 25 (9%) were affected by a genetic syndrome. The median age was 38 (29-51) years, whereas the median time interval between the last visit and the telematic follow-up was 9.5 (7.5-11.5) months. Overall, 35 patients (12%) reported a worsening of fatigue in daily life activity, 17 (6%) experienced chest pain, 42 (15%) had presyncope and 2 (1%) syncope; in addition, 28 patients (10%) presented peripheral edema and 14 (5%) were orthopneic. A total of 116 (40%) patients reported palpitations and 12 had at least one episode of atrial fibrillation and underwent successful electrical (8) or pharmacological (4) cardioversion. One patient was admitted to the emergency department for uncontrolled arterial hypertension, five for chest pain, and one for heart failure. Two patients presented fever but both had negative COVID-19 nasal swab. CONCLUSION: During the COVID-19 pandemic, the use of telemedicine dramatically increased and here we report a positive experience in ACHD patients. The postpandemic role of telemedicine will depend on permanent regulatory solutions and this early study might encourage a more systematic telematic approach for ACHD patients.


Subject(s)
COVID-19 , Heart Defects, Congenital , Infection Control , Patient Care Management , Patient Preference/statistics & numerical data , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Female , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/therapy , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Outcome and Process Assessment, Health Care , Patient Care Management/methods , Patient Care Management/statistics & numerical data , Prospective Studies , SARS-CoV-2 , Surveys and Questionnaires , Symptom Assessment/methods , Telemedicine/methods , Telemedicine/organization & administration
12.
Open Heart ; 8(1)2021 04.
Article in English | MEDLINE | ID: covidwho-1197278

ABSTRACT

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.


Subject(s)
COVID-19 , Eisenmenger Complex/epidemiology , Fontan Procedure/statistics & numerical data , Heart Defects, Congenital , Pulmonary Arterial Hypertension/epidemiology , Risk Assessment/methods , COVID-19/diagnosis , COVID-19/epidemiology , Europe/epidemiology , Global Burden of Disease , Heart Defects, Congenital/classification , Heart Defects, Congenital/epidemiology , Humans , Outcome Assessment, Health Care/methods , Prognosis , Risk Factors , SARS-CoV-2 , Societies, Medical , Surveys and Questionnaires
13.
Sci Rep ; 11(1): 8449, 2021 04 19.
Article in English | MEDLINE | ID: covidwho-1193601

ABSTRACT

Although most patients recover from COVID-19, it has been linked to cardiac, pulmonary, and neurologic complications. Despite not having formal criteria for its diagnosis, COVID-19 associated cardiomyopathy has been observed in several studies through biomarkers and imaging. This study aims to estimate the proportion of COVID-19 patients with cardiac abnormalities and to determine the association between the cardiac abnormalities in COVID-19 patients and disease severity and mortality. Observational studies published from December 1, 2019 to September 30, 2020 were obtained from electronic databases (PubMed, Embase, Cochrane Library, CNKI) and preprint servers (medRxiv, bioRxiv, ChinaXiv). Studies that have data on prevalence were included in the calculation of the pooled prevalence, while studies with comparison group were included in the calculation of the odds ratio. If multiple tests were done in the same study yielding different prevalence values, the largest one was used as the measure of prevalence of that particular study. Metafor using R software package version 4.0.2 was used for the meta-analysis. A total of 400 records were retrieved from database search, with 24 articles included in the final analysis. Pooled prevalence of cardiac abnormalities in 20 studies was calculated to be 0.31 [95% Confidence Intervals (CI) of (0.23; 0.41)], with statistically significant heterogeneity (percentage of variation or I-squared statistic I2 = 97%, p < 0.01). Pooled analysis of 19 studies showed an overall odds ratio (OR) of 6.87 [95%-CI (3.92; 12.05)] for cardiac abnormalities associated with disease severity and mortality, with statistically significant heterogeneity (I2 = 85%, between-study variance or tau-squared statistic τ2 = 1.1485, p < 0.01). Due to the high uncertainty in the pooled prevalence of cardiac abnormalities and the unquantifiable magnitude of risk (although an increased risk is certain) for severity or mortality among COVID-19 patients, much more long-term prognostic studies are needed to check for the long-term complications of COVID-19 and formalize definitive criteria of "COVID-19 associated cardiomyopathy".


Subject(s)
COVID-19/pathology , Heart Defects, Congenital/pathology , COVID-19/complications , COVID-19/virology , Heart Defects, Congenital/complications , Heart Defects, Congenital/epidemiology , Hospitalization , Humans , Odds Ratio , Prevalence , Prognosis , Risk Factors , SARS-CoV-2/isolation & purification , Severity of Illness Index
14.
Saudi Med J ; 42(4): 391-398, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1168263

ABSTRACT

OBJECTIVES: To determine the demographic and clinical characteristics, underlying comorbidities, and outcomes of children with coronavirus disease 2019 (COVID-19) infection. METHODS: In this retrospective study, we reported 62 pediatric patients (age <14 years) with confirmed COVID-19 between March 2 and July 1, 2020, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. RESULTS: Comorbid conditions, including cardiac, neurological, respiratory, and malignant disorders, were reported in 9 patients (14.5%). The most prominent presenting complaints were fever (80.6%) and cough (48.4%). Most of our patients (80.6%) had mild disease, 11.3% had moderate disease, and 8.1% exhibited severe and critical illness. Twenty-one patients (33.9%) were hospitalized, with 4 patients (6.5%) admitted to the pediatric intensive care unit, and 3 (4.8%) patients died. CONCLUSION: All pediatric age groups are susceptible to COVID-19, with no gender difference. COVID-19 infection may result in critical illness and even mortality in subsets of pediatric patients.


Subject(s)
COVID-19/physiopathology , Abdominal Pain/physiopathology , Adolescent , Asthma/epidemiology , Atrophy , Brain/pathology , Bronchiolitis Obliterans/epidemiology , COVID-19/blood , COVID-19/epidemiology , COVID-19/therapy , Child , Child, Preschool , Comorbidity , Cough/physiopathology , Diarrhea/physiopathology , Dyspnea/physiopathology , Female , Fever/physiopathology , Heart Defects, Congenital/epidemiology , Hospital Mortality , Hospitalization , Humans , Hydrocephalus/epidemiology , Infant , Intensive Care Units, Pediatric , Male , Pharyngitis/physiopathology , Respiration, Artificial , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Retrospective Studies , Rhinorrhea/physiopathology , SARS-CoV-2 , Saudi Arabia/epidemiology , Severity of Illness Index , Vomiting/physiopathology
15.
J Am Coll Cardiol ; 77(13): 1644-1655, 2021 04 06.
Article in English | MEDLINE | ID: covidwho-1147716

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.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Cyanosis , Heart Defects, Congenital , Hypertension, Pulmonary , Adult , COVID-19/mortality , COVID-19/therapy , COVID-19 Testing/methods , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/statistics & numerical data , Causality , Comorbidity , Cyanosis/diagnosis , Cyanosis/etiology , Cyanosis/mortality , Female , Global Health/statistics & numerical data , Heart Defects, Congenital/classification , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/therapy , Hospitalization/statistics & numerical data , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/mortality , Male , Mortality , Patient Acuity , Risk Factors , SARS-CoV-2/isolation & purification , Symptom Assessment
16.
Indian J Pediatr ; 88(9): 899-904, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1146195

ABSTRACT

OBJECTIVE: To study the impact of coronavirus disease 2019 (COVID-19) pandemic on the utilization of pediatric cardiac care services and to determine the role of teleconsultation services in delivering healthcare in this subset of population. METHODS: It was a retrospective, observational study. All children who attended pediatric cardiology outpatient/teleconsultation services or were admitted to pediatric cardiology ward between April 1, 2019 to July 31, 2019 and April 1, 2020 to July 31, 2020, were recruited in the study. Data for patients who underwent surgery or catheter intervention for congenital heart disease were also recorded and analyzed. Comparisons were drawn between the statistics during the two time-periods. RESULTS: Physical outpatient services were discontinued and were replaced by teleconsultations from April 2020. Inpatient admissions during COVID-19 pandemic (n = 66) decreased by two-thirds as compared to the admissions during similar period in 2019 (n = 189). Similarly, the percentage decrease during these 4 mo of pandemic were 84% for catheter interventions, 90% for total congenital heart disease (CHD) surgeries, and 40% for emergency CHD surgeries. The number of patients availing successful teleconsultation was 1079, which was only 15% of the total number of patients attending physical outpatient services (n = 7176) during the corresponding period in the year 2019. During the pandemic, systematic teleconsultation and local evaluation and investigations aided in better management of patients with CHD. CONCLUSIONS: The utilization of cardiovascular services for CHD has reduced significantly during COVID-19 pandemic, for both out- and inpatient care. Teleconsultation services have streamlined the follow-up care to some extent and have helped in noncontact triaging of these patients for further care.


Subject(s)
COVID-19 , Heart Defects, Congenital , Child , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/therapy , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
17.
Nat Rev Cardiol ; 18(6): 387, 2021 06.
Article in English | MEDLINE | ID: covidwho-1142444
18.
J Investig Med ; 69(7): 1372-1376, 2021 10.
Article in English | MEDLINE | ID: covidwho-1133307

ABSTRACT

We performed a retrospective study of cardiology telemedicine visits at a large academic pediatric center between 2016 and 2019 (pre COVID-19). Telemedicine patient visits were matched to data from their previous in-person visits, to evaluate any significant differences in total charge, insurance compensation, patient payment, percent reimbursement and zero reimbursement. Miles were measured between patient's home and the address of previous visit. We found statistically significant differences in mean charges of telemedicine versus in-person visits (2019US$) (172.95 vs 218.27, p=0.0046), patient payment for telemedicine visits versus in-person visits (2019US$) (11.13 vs 62.83, p≤0.001), insurance reimbursement (2019US$) (65.18 vs 110.85, p≤0.001) and insurance reimbursement rate (43% vs 61%, p=0.0029). Rate of zero reimbursement was not different. Mean distance from cardiology clinic was 35 miles. No adverse outcomes were detected. This small retrospective study showed cost reduction and a decrease in travel time for families participating in telemedicine visits. Future work is needed to enhance compensation for telemedicine visits.


Subject(s)
Ambulatory Care , Cardiology Service, Hospital , Cardiovascular Diseases , Costs and Cost Analysis , Telemedicine , Ambulatory Care/economics , Ambulatory Care/methods , Ambulatory Care/organization & administration , COVID-19/epidemiology , Cardiology Service, Hospital/economics , Cardiology Service, Hospital/trends , Cardiovascular Diseases/economics , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Child , Cost Savings/methods , Costs and Cost Analysis/methods , Costs and Cost Analysis/statistics & numerical data , Family Health , Female , Health Services Accessibility/economics , Heart Defects, Congenital/economics , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/therapy , Humans , Male , Retrospective Studies , SARS-CoV-2 , Telemedicine/economics , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , United States/epidemiology
19.
West Afr J Med ; 38(2): 105-106, 2021 Feb.
Article in English, French | MEDLINE | ID: covidwho-1102880
20.
Pediatr Rheumatol Online J ; 19(1): 21, 2021 Feb 24.
Article in English | MEDLINE | ID: covidwho-1102340

ABSTRACT

IMPORTANCE: Active pediatric COVID-19 pneumonia and MIS-C are two disease processes requiring rapid diagnosis and different treatment protocols. OBJECTIVE: To distinguish active pediatric COVID-19 pneumonia and MIS-C using presenting signs and symptoms, patient characteristics, and laboratory values. DESIGN: Patients diagnosed and hospitalized with active COVID-19 pneumonia or MIS-C at Children's of Alabama Hospital in Birmingham, AL from April 1 through September 1, 2020 were identified retrospectively. Active COVID-19 and MIS-C cases were defined using diagnostic codes and verified for accuracy using current US Centers for Disease Control case definitions. All clinical notes were reviewed for documentation of COVID-19 pneumonia or MIS-C, and clinical notes and electronic medical records were reviewed for patient demographics, presenting signs and symptoms, prior exposure to or testing for the SARS-CoV-2 virus, laboratory data, imaging, treatment modalities and response to treatment. FINDINGS: 111 patients were identified, with 74 classified as mild COVID-19, 8 patients as moderate COVID-19, 8 patients as severe COVID-19, 10 as mild MIS-C and 11 as severe MIS-C. All groups had a male predominance, with Black and Hispanic patients overrepresented as compared to the demographics of Alabama. Most MIS-C patients were healthy at baseline, with most COVID-19 patients having at least one underlying illness. Fever, rash, conjunctivitis, and gastrointestinal symptoms were predominant in the MIS-C population whereas COVID-19 patients presented with predominantly respiratory symptoms. The two groups were similar in duration of symptomatic prodrome and exposure history to the SARS-CoV-2 virus, but MIS-C patients had a longer duration between presentation and exposure history. COVID-19 patients were more likely to have a positive SAR-CoV-2 PCR and to require respiratory support on admission. MIS-C patients had lower sodium levels, higher levels of C-reactive protein, erythrocyte sedimentation rate, d-dimer and procalcitonin. COVID-19 patients had higher lactate dehydrogenase levels on admission. MIS-C patients had coronary artery changes on echocardiography more often than COVID-19 patients. CONCLUSIONS AND RELEVANCE: This study is one of the first to directly compare COVID-19 and MIS-C in the pediatric population. The significant differences found between symptoms at presentation, demographics, and laboratory findings will aide health-care providers in distinguishing the two disease entities.


Subject(s)
COVID-19/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Abdominal Pain/physiopathology , Adolescent , African Americans , Asthma/epidemiology , C-Reactive Protein/metabolism , COVID-19/epidemiology , COVID-19/metabolism , Case-Control Studies , Child , Child, Preschool , Comorbidity , Conjunctivitis/physiopathology , Coronary Artery Disease , Diabetes Mellitus/epidemiology , Diarrhea/physiopathology , Dilatation, Pathologic , Echocardiography , Exanthema/physiopathology , Female , Fever/physiopathology , Heart Defects, Congenital/epidemiology , Humans , Hyponatremia/metabolism , Male , Nausea/physiopathology , Neoplasms/epidemiology , Neurodevelopmental Disorders/epidemiology , Obesity/epidemiology , SARS-CoV-2 , Severity of Illness Index , Sex Distribution , Stroke Volume , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/metabolism , Time Factors , Vomiting/physiopathology
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