Trends in mortality risk of patients with congenital heart disease during the COVID-19 pandemic.

BACKGROUND: Cardiovascular conditions are considered risk factors for poor outcomes associated with COVID-19. However, the effect of the COVID-19 pandemic on the mortality of patients with congenital heart disease (CHD) is unclear. Our study aims to examine the trends in mortality risk of CHD patients during the COVID-19 pandemic. METHODS: This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a US-based registry of interventions for CHD. We included patients having US residence and direct identifiers; death events were captured by matching with the National Death Index. The observation window (2017-2022) was divided into pre-COVID-19 and COVID-19 era defined around the national onset of COVID-19 disease in 2020. Stratified Cox model was used to assess all-cause mortality between the pre- and the COVID-19 era. RESULTS: Among 45,130 patients with CHD (median age in 2017: 23.3 years, IQR: 19.0-28.4), 503 deaths occurred during the pandemic with 44 deaths (8.7%) attributed to COVID-19 (COVID-19 mortality rate of 0.09%). The overall risk of death for patients with all types of CHD during the pandemic was significantly higher compared to the pre-COVID-19 era (aHR 1.28, 95%CI: 1.08-1.53), with a differential trend towards increased risk in patients with two-ventricle (aHR 1.44, 95% CI: 1.19-1.76) vs unchanged risk for those with single ventricle CHD (aHR = 0.83, 95% CI: 0.57-1.21). Adjusted subgroup analysis revealed a higher risk of death during the pandemic for CHD patients with male and chromosomal abnormalities. The excess deaths during the pandemic were attributed to COVID-19 itself rather than CHD or cardiovascular conditions. CONCLUSION: In this large CHD cohort study, there was a higher risk of death among CHD patients with male and chromosomal abnormalities. A differential trend towards higher risk for those with two vs. unchanged risk for single ventricle CHD was presented. The excess mortality was attributed to the COVID-19 itself and not to conditions potentially related to deferral of care. These results justify targeted protective measures towards the CHD population and may provide guidance for public health and medical care response in future epidemics.

Quality improvement in screening for critical congenital heart disease.

OBJECTIVES: Screening for critical congenital heart disease with pulse oximetry requires healthcare providers to decipher a previously published algorithm, a feature that raises concerns about quality of interpretation of pulse oximetry results. We hypothesized that this method would be prone to error and a computer-based tool would lead to a more accurate interpretation of the screening results. STUDY DESIGN: In this randomized crossover study, healthcare providers with prior experience using pulse oximetry received 2 sets of 10 mock screening scenarios and were asked to interpret the results of each scenario as "pass," "fail," or "retest." Participants were randomized to use either the paper algorithm or computer-based tool for the first set of 10 scenarios and the alternative method for the second set. We used Wilcoxon rank sum tests to compare the accuracy of interpretation using the 2 methods. RESULTS: The 102 participants answered 81.6% of the scenarios correctly when manually interpreting the algorithm vs 98.3% correct when using the computer-based tool (P < .001). These differences were most pronounced for the "fail" scenarios (65.4% manual vs 96.7% computer, P < .001) and the "retest" scenarios (80.7% manual vs 98.7% computer, P < .001), but were also significant for the "pass" scenarios (94.1% manual vs 99.0% computer, P < .001). CONCLUSIONS: Use of a manual algorithm for the interpretation of results in screening for critical congenital heart disease with pulse oximetry is susceptible to human error. Implementation of a computer-based tool to aid in the interpretation of the results may lead to improved accuracy and quality.