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New Study Probes Relationship Between ACHD and COVID-19

June 12, 2021

A new multicenter international study, published in April in the Journal of the American College of Cardiology, examined the relationship between patients with adult congenital heart disease (ACHD) and their risk factors for disease course severity and outcomes from COVID-19 infection. Arvind Hoskoppal, MD, MHS, director of the UPMC Adult Congenital Heart Disease Program, was a co-author of the paper, and UPMC Children's Hospital of Pittsburgh contributed data on its ACHD patients to the study.

Given that most patients with chronic health conditions such as diabetes or hypertension have been deemed to be at high risk for severe manifestations of COVID-19, patients with various forms of ACHD were presumed to a high-risk population for severe complications or death from the novel coronavirus.

However, it was not explicitly known which forms of ACHD may pose more relative risk to patients if they contract COVID-19, nor was the association or contribution of other underlying or associated conditions such as obesity and hypertension in this patient population. Risk factors such as age, sex, weight, and race, which are predictive of COVID-19 disease severity and complications in the general population, had not been assessed specifically in the ACHD population. 

“Categorizing and stratifying risk of disease complications in patients with ACHD who contract COVID-19 is highly important for informing treating physicians and patients on their risk profile and potential mitigating factors. This large international study was designed to analyze COVID-19 in this patient population and look for those factors which may portend a worse prognosis or more severe complications in the presence of COVID-19 infection,” says Dr. Hoskoppal.

Key Findings

First, the study uncovered that mortality from COVID-19 was comparable in ACHD patients and the general population, 2.3% and 2.2%, respectively.

The complexity of an ACHD patient’s underlying anatomy or their specific form or ACHD was not found to increase their risk for severe COVID-19 infection or mortality from the disease. However, the patient’s physiological state was predictive of higher mortality risk: the worse the patient’s physiological state, the higher the risk of mortality.

Several co-morbid conditions accompanying a patient's underlying ACHD were also predictive of more severe COVID-19 manifestations and mortality. Cyanosis, pulmonary hypertension, and Eisenmenger physiology presented a higher risk for complications and death from COVID-19. Patients with renal insufficiency and those hospitalized previously for heart failure also were at higher risk for complications and COVID-19 mortality.

As with the general population, males were more at risk than females for disease severity and death, as were those with diabetes.

"These are important findings for this patient population. The study uncovered several important physiologic and disease-specific factors that can lead to severe COVID-19 cases and a higher risk for mortality. The study adds important data to help manage this vulnerable patient population while COVID-19 continues to circulate widely across the globe. More work will be required to better understand any specific long-term effects in this patient population who contract COVID-19 and recover," says Dr. Hoskoppal.


Broberg CS, et al. COVID-19 in Adults With Congenital Heart Disease. J Am Coll Cardiol. 2021; 77(13): 1644-1655.