Lessons learnt from COVID-19 in Adult Congenital Heart Patient in Tehran: A survey-based study of prevention, exposure, susceptibility, and outcomes.

Background COVD-19 pandemic has overwhelmed many healthcare systems worldwide. Underlying cardiovascular disease predisposes to greater disease susceptibility and more complications including mortality. Such data is unverified in adults with congenital heart disease (ACHD). The aim of the study is to report the Tehran experience with respect to preventative self-care measures, disease exposure, susceptibility and outcomes after COVD-19 infection in ACHD patients. Methods A telephone-based survey was conducted in ACHD patients, focusing on new onset symptoms that might indicate COVID-19 infection, prevention measures, confirmed infection rates, and outcomes. Results 309 ACHD patients, mean age 29.13 years (14-72 years, SD=10.64), 170 (55%) women, were assessed. The majority (86.7%) had moderate or complex ACHD. Two-thirds (67.3%) of patients practiced high level preventative self-care measures. After community exposure, 33.3% developed COVID-19, and after household exposure 43.7% developed COVID-19. There was only 1 mortality in a post-operative patient. Thirty-seven patients (12%) reported new symptoms including cough (10%), fatigue (8%), fever (7%) and new dyspnea (6.5%). Among 18 (6%) with confirmed COVID-19 there was only 1 mortality in a postoperative patient. Age (adjusted OR=1.19, 95% CI: 1.07-1.31, p = 0.001), contact with confirmed COVID-19 cases (adjusted OR=59.34, 95% CI: 3.68-955.10, p = 0.004) were independently associated with COVID-19 infection. Conclusions Mortality risk associated with COVID-19 infection in ACHD patients with moderate or severe disease appears to be relatively low, similar to the general population. Such risk appears to act through conventional risk factors, and in this cohort, we demonstrated age as a significant risk factor in addition to exposure to the development of COVID-19 infection. Preventative self-care measures are a potentially significant and impactful intervention target for intervention and for improving outcomes. Self-care measures, disease exposure and susceptibility, and symptoms related to COVID-19 were assessed in a survey of 309 ACHD patients in Tehran. Approximately two thirds of patients practiced higher level preventative self-care measures. Thirty-seven patients (12%) reported new symptoms including cough (10%), fatigue (8%), fever (7%) and new dyspnea (6.5%). Of 18 (6%) with confirmed COVID-19, one post-operative mortality was documented, and disease was mild in the remainder. Age and contact with confirmed COVID-19 patients were independently associated with acquiring COVID-19 infection.