Adult congenital heart disease and the COVID-19 pandemic
Adults with congenital heart disease (ACHD) may be at high risk in the case of COVID-19. Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease preven...
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Veröffentlicht in: | Heart (British Cardiac Society) 2020-09, Vol.106 (17), p.1302-1309 |
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description | Adults with congenital heart disease (ACHD) may be at high risk in the case of COVID-19. Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease prevention and management. Based on anatomy and additional physiological factors including symptoms, exercise capacity, heart failure, pulmonary hypertension and cyanosis, we propose a pragmatic approach to categorising patients into low-risk, intermediate-risk and high-risk groups. We regard especially patients with complex cyanotic conditions, those with palliated univentricular hearts, heart failure, severe valvular disease or pulmonary hypertension as high-risk patients. To avoid infection, we recommend self-isolation and exemption from work for these cohorts. Infected ACHD patients with low or moderate risk and without signs of deterioration may be remotely followed and cared for at home while in self isolation. High-risk patients or those with signs of respiratory or cardiovascular impairment require admission ideally at a tertiary ACHD centre. Especially patients with complex, cyanotic disease, heart failure and arrhythmias require particular attention. Treatment in patients with cyanotic heart disease should be guided by the relative degree of desaturation compared with baseline and lactate levels rather than absolute oxygen saturation levels. Patients with right heart dilatation or dysfunction are potentially at increased risk of right heart failure as mechanical ventilation and acute respiratory distress syndrome can lead to increase in pulmonary arterial pressures. |
doi_str_mv | 10.1136/heartjnl-2020-317258 |
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Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease prevention and management. Based on anatomy and additional physiological factors including symptoms, exercise capacity, heart failure, pulmonary hypertension and cyanosis, we propose a pragmatic approach to categorising patients into low-risk, intermediate-risk and high-risk groups. We regard especially patients with complex cyanotic conditions, those with palliated univentricular hearts, heart failure, severe valvular disease or pulmonary hypertension as high-risk patients. To avoid infection, we recommend self-isolation and exemption from work for these cohorts. Infected ACHD patients with low or moderate risk and without signs of deterioration may be remotely followed and cared for at home while in self isolation. High-risk patients or those with signs of respiratory or cardiovascular impairment require admission ideally at a tertiary ACHD centre. Especially patients with complex, cyanotic disease, heart failure and arrhythmias require particular attention. Treatment in patients with cyanotic heart disease should be guided by the relative degree of desaturation compared with baseline and lactate levels rather than absolute oxygen saturation levels. Patients with right heart dilatation or dysfunction are potentially at increased risk of right heart failure as mechanical ventilation and acute respiratory distress syndrome can lead to increase in pulmonary arterial pressures.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2020-317258</identifier><identifier>PMID: 32522822</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Adult ; Adults ; Bacterial infections ; Betacoronavirus ; Cardiology ; Cardiovascular disease ; Communicable Disease Control - methods ; Congenital diseases ; congenital heart disease ; Coronavirus Infections - epidemiology ; Coronavirus Infections - prevention & control ; Coronaviruses ; COVID-19 ; Critical care ; Cytokines ; Disease prevention ; Disease transmission ; Dyspnea ; Fever ; Heart Defects, Congenital - classification ; Heart Defects, Congenital - physiopathology ; Heart Defects, Congenital - therapy ; Heart failure ; Humans ; Hypoxia ; Infections ; Influenza ; Laboratories ; Pandemics ; Pandemics - prevention & control ; Patient Care Management - methods ; Peptides ; Pneumonia ; Pneumonia, Viral - epidemiology ; Pneumonia, Viral - prevention & control ; Respiratory distress syndrome ; Respiratory system ; Review ; Risk Assessment ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Ventilators</subject><ispartof>Heart (British Cardiac Society), 2020-09, Vol.106 (17), p.1302-1309</ispartof><rights>Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2020 Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b517t-c56a7d1138afad731d18548470eb75333391fa69b046a537b72b8ec80fb7aaee3</citedby><cites>FETCH-LOGICAL-b517t-c56a7d1138afad731d18548470eb75333391fa69b046a537b72b8ec80fb7aaee3</cites><orcidid>0000-0003-3050-5248 ; 0000-0003-3988-7131 ; 0000-0002-5055-2220</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299644/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299644/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32522822$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Radke, Robert M</creatorcontrib><creatorcontrib>Frenzel, Tim</creatorcontrib><creatorcontrib>Baumgartner, Helmut</creatorcontrib><creatorcontrib>Diller, Gerhard-Paul</creatorcontrib><title>Adult congenital heart disease and the COVID-19 pandemic</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><addtitle>Heart</addtitle><description>Adults with congenital heart disease (ACHD) may be at high risk in the case of COVID-19. Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease prevention and management. Based on anatomy and additional physiological factors including symptoms, exercise capacity, heart failure, pulmonary hypertension and cyanosis, we propose a pragmatic approach to categorising patients into low-risk, intermediate-risk and high-risk groups. We regard especially patients with complex cyanotic conditions, those with palliated univentricular hearts, heart failure, severe valvular disease or pulmonary hypertension as high-risk patients. To avoid infection, we recommend self-isolation and exemption from work for these cohorts. Infected ACHD patients with low or moderate risk and without signs of deterioration may be remotely followed and cared for at home while in self isolation. High-risk patients or those with signs of respiratory or cardiovascular impairment require admission ideally at a tertiary ACHD centre. Especially patients with complex, cyanotic disease, heart failure and arrhythmias require particular attention. Treatment in patients with cyanotic heart disease should be guided by the relative degree of desaturation compared with baseline and lactate levels rather than absolute oxygen saturation levels. Patients with right heart dilatation or dysfunction are potentially at increased risk of right heart failure as mechanical ventilation and acute respiratory distress syndrome can lead to increase in pulmonary arterial pressures.</description><subject>Adult</subject><subject>Adults</subject><subject>Bacterial infections</subject><subject>Betacoronavirus</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Communicable Disease Control - methods</subject><subject>Congenital diseases</subject><subject>congenital heart disease</subject><subject>Coronavirus Infections - epidemiology</subject><subject>Coronavirus Infections - prevention & control</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Critical care</subject><subject>Cytokines</subject><subject>Disease prevention</subject><subject>Disease transmission</subject><subject>Dyspnea</subject><subject>Fever</subject><subject>Heart Defects, Congenital - classification</subject><subject>Heart Defects, Congenital - physiopathology</subject><subject>Heart Defects, Congenital - therapy</subject><subject>Heart failure</subject><subject>Humans</subject><subject>Hypoxia</subject><subject>Infections</subject><subject>Influenza</subject><subject>Laboratories</subject><subject>Pandemics</subject><subject>Pandemics - prevention & control</subject><subject>Patient Care Management - methods</subject><subject>Peptides</subject><subject>Pneumonia</subject><subject>Pneumonia, Viral - epidemiology</subject><subject>Pneumonia, Viral - prevention & control</subject><subject>Respiratory distress syndrome</subject><subject>Respiratory system</subject><subject>Review</subject><subject>Risk Assessment</subject><subject>SARS-CoV-2</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Ventilators</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkUtLAzEUhYMotlb_gciAGzdj85wkG6HUV6HgRsVdyMzcaafMo05mBP-9qX34WIjJIpeb7xzu5SB0SvAlISwazsE27aIqQoopDhmRVKg91Cc8Ur5FXvZ9zYQII8xkDx05t8AYc62iQ9RjVFCqKO0jNUq7og2SuppBlbe2CD59gzR3YB0EtkqDdg7B-OF5ch0SHSx9B8o8OUYHmS0cnGzeAXq6vXkc34fTh7vJeDQNY0FkGyYisjL1Ayub2VQykhIluOISQywF80eTzEY6xjyygslY0lhBonAWS2sB2ABdrX2XXVxCmkDVNrYwyyYvbfNuapubnz9VPjez-s1IqnXEuTe42Bg09WsHrjVl7hIoCltB3TlDOaEUa661R89_oYu6ayq_nqcYI9Rf4Sm-ppKmdq6BbDcMwWYVjdlGY1bRmHU0Xnb2fZGdaJuFB4ZrIC4X_7XEX4rdqH9KPgAruKlP</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Radke, Robert M</creator><creator>Frenzel, Tim</creator><creator>Baumgartner, Helmut</creator><creator>Diller, Gerhard-Paul</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3050-5248</orcidid><orcidid>https://orcid.org/0000-0003-3988-7131</orcidid><orcidid>https://orcid.org/0000-0002-5055-2220</orcidid></search><sort><creationdate>20200901</creationdate><title>Adult congenital heart disease and the COVID-19 pandemic</title><author>Radke, Robert M ; Frenzel, Tim ; Baumgartner, Helmut ; Diller, Gerhard-Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b517t-c56a7d1138afad731d18548470eb75333391fa69b046a537b72b8ec80fb7aaee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Adults</topic><topic>Bacterial infections</topic><topic>Betacoronavirus</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Communicable Disease Control - methods</topic><topic>Congenital diseases</topic><topic>congenital heart disease</topic><topic>Coronavirus Infections - epidemiology</topic><topic>Coronavirus Infections - prevention & control</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Critical care</topic><topic>Cytokines</topic><topic>Disease prevention</topic><topic>Disease transmission</topic><topic>Dyspnea</topic><topic>Fever</topic><topic>Heart Defects, Congenital - classification</topic><topic>Heart Defects, Congenital - physiopathology</topic><topic>Heart Defects, Congenital - therapy</topic><topic>Heart failure</topic><topic>Humans</topic><topic>Hypoxia</topic><topic>Infections</topic><topic>Influenza</topic><topic>Laboratories</topic><topic>Pandemics</topic><topic>Pandemics - prevention & control</topic><topic>Patient Care Management - methods</topic><topic>Peptides</topic><topic>Pneumonia</topic><topic>Pneumonia, Viral - epidemiology</topic><topic>Pneumonia, Viral - prevention & control</topic><topic>Respiratory distress syndrome</topic><topic>Respiratory system</topic><topic>Review</topic><topic>Risk Assessment</topic><topic>SARS-CoV-2</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Radke, Robert M</creatorcontrib><creatorcontrib>Frenzel, Tim</creatorcontrib><creatorcontrib>Baumgartner, Helmut</creatorcontrib><creatorcontrib>Diller, Gerhard-Paul</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Radke, Robert M</au><au>Frenzel, Tim</au><au>Baumgartner, Helmut</au><au>Diller, Gerhard-Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adult congenital heart disease and the COVID-19 pandemic</atitle><jtitle>Heart (British Cardiac Society)</jtitle><stitle>Heart</stitle><addtitle>Heart</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>106</volume><issue>17</issue><spage>1302</spage><epage>1309</epage><pages>1302-1309</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>Adults with congenital heart disease (ACHD) may be at high risk in the case of COVID-19. Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease prevention and management. Based on anatomy and additional physiological factors including symptoms, exercise capacity, heart failure, pulmonary hypertension and cyanosis, we propose a pragmatic approach to categorising patients into low-risk, intermediate-risk and high-risk groups. We regard especially patients with complex cyanotic conditions, those with palliated univentricular hearts, heart failure, severe valvular disease or pulmonary hypertension as high-risk patients. To avoid infection, we recommend self-isolation and exemption from work for these cohorts. Infected ACHD patients with low or moderate risk and without signs of deterioration may be remotely followed and cared for at home while in self isolation. High-risk patients or those with signs of respiratory or cardiovascular impairment require admission ideally at a tertiary ACHD centre. Especially patients with complex, cyanotic disease, heart failure and arrhythmias require particular attention. Treatment in patients with cyanotic heart disease should be guided by the relative degree of desaturation compared with baseline and lactate levels rather than absolute oxygen saturation levels. Patients with right heart dilatation or dysfunction are potentially at increased risk of right heart failure as mechanical ventilation and acute respiratory distress syndrome can lead to increase in pulmonary arterial pressures.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>32522822</pmid><doi>10.1136/heartjnl-2020-317258</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-3050-5248</orcidid><orcidid>https://orcid.org/0000-0003-3988-7131</orcidid><orcidid>https://orcid.org/0000-0002-5055-2220</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Adult Adults Bacterial infections Betacoronavirus Cardiology Cardiovascular disease Communicable Disease Control - methods Congenital diseases congenital heart disease Coronavirus Infections - epidemiology Coronavirus Infections - prevention & control Coronaviruses COVID-19 Critical care Cytokines Disease prevention Disease transmission Dyspnea Fever Heart Defects, Congenital - classification Heart Defects, Congenital - physiopathology Heart Defects, Congenital - therapy Heart failure Humans Hypoxia Infections Influenza Laboratories Pandemics Pandemics - prevention & control Patient Care Management - methods Peptides Pneumonia Pneumonia, Viral - epidemiology Pneumonia, Viral - prevention & control Respiratory distress syndrome Respiratory system Review Risk Assessment SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Ventilators |
title | Adult congenital heart disease and the COVID-19 pandemic |
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