Pharmacists should be aware that patients with congenital heart defects (CHDs) are at a much higher risk for severe COVID-19 and need to take greater precautions.

A research letter published in Circulation pointed out that that cohorts who were hospitalized with COVID-19 infection were at higher risk for severe illness or death than those without a CHD. They were also more likely to require treatment in the ICU or need a ventilator.

Aged 50 years and older or male sex placed those patients at even greater risk, according to the CDC researchers.

More than a dozen types of CHDs can result when the heart or nearby blood vessels do not develop normally. In fact, the American Heart Association states CHDs are the most common birth defect worldwide, with a global prevalence of 157 per 100,000 in 2017. The most common is ventricular septal defect.

"Data comparing COVID-19 outcomes among individuals with and without congenital heart defects has been limited," explained lead author Karrie Downing, MPH, an epidemiologist at the National Center on Birth Defects and Developmental Disabilities and the COVID-19 Response Team at the CDC in Atlanta.

Data on hospitalized COVID-19 patients from March 2020 to January 2021 came from the Premier Healthcare Database Special COVID-19 Release, which represents about 20% of all U.S. hospitalizations. It included more than 235,000 patients, aged 1 to 64 years old, who were hospitalized for COVID-19, and 421 (0.2%) had a CHD.

Researchers divided patients into two groups: those who had a CHD and those who did not. The study team assessed how many in each group required admission to the ICU, needed a ventilator to help with breathing, or those who died, while also reviewing other demographic and health characteristics.

Of the study participants:

• Most of the patients with CHDs were older than age 30 years (73%), and 61% were male; 55% were non-Hispanic white, 19% Hispanic, and 16% non-Hispanic Black.
• 68% of the patients with a CHD also had at least one other health condition noted, compared with 59% without a CHD.
• 54% of patients with a CHD were admitted to the ICU, compared with 43% of those without a CHD.
• 24% of patients with a CHD required a ventilator to breathe, compared with 15% of those without a CHD.
• 11% of patients with a CHD died during hospitalization, compared with 7% of those without a CHD.

Even when taking age and other health conditions into account, researchers found that patients with CHDs consistently remained at higher risk for severe COVID-19 illness.

"People with heart defects should be encouraged to receive the COVID-19 vaccines and boosters and to continue to practice additional preventive measures for COVID-19, such as mask-wearing and physical distancing," Ms. Downing advised. "People with heart defects should also consult with their health care teams about additional steps to manage personal risks related to COVID-19, given the significantly increased risk of severe infection and serious complications."

She noted that not all patients with heart defects who were hospitalized with COVID-19 had poor outcomes, adding, "More work is needed to identify why the clinical course of COVID-19 disease results in significantly worse outcomes for some hospitalized patients with risk factors for critical COVID-19 illness, like heart defects, and not for others."

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