{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T07:18:52Z","timestamp":1763018332498,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2021,3,22]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Adults with congenital heart disease (ACHD) may be at a higher risk of a fatal outcome in case of COVID-19. Current risk stratification among these patients relies on personal experience and extrapolation from patients with acquired heart disease. We aimed to provide an expert view on risk stratification while awaiting results from observational studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study was an initiative of the EPOCH (European Collaboration for Prospective Outcome Research in Congenital Heart disease). Among nine European countries (Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain and Switzerland), 24 experts from 23 tertiary ACHD centres participated in the survey. ACHD experts were asked to identify ACHD-specific COVID-19 risk factors from a list of potential outcome predictors and to estimate the risk of adverse COVID-19 outcomes in seven commonly seen patient scenarios.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>82% of participants did not consider all ACHD patients at risk of COVID-19 related complications. There was a consensus on pulmonary arterial hypertension, Fontan physiology and cyanotic heart disease as risk factors for adverse outcomes. Among different ACHD scenarios, a patient with Eisenmenger syndrome was considered to be at the highest risk. There was a marked variability in risk estimation among the other potential outcome predictors and ACHD scenarios.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Pulmonary arterial hypertension, Fontan palliation and cyanotic heart disease were widely considered as risk factors for poor outcome in COVID-19. However, there was a marked disparity in risk estimation for other clinical scenarios. We are in urgent need of outcome studies in ACHD suffering from COVID-19.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2020-001455","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T12:24:06Z","timestamp":1619007846000},"page":"e001455","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Risk stratification of adults with congenital heart disease during the COVID-19 pandemic: insights from a multinational survey among European experts"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9904-0402","authenticated-orcid":false,"given":"Francisco Javier","family":"Ruperti-Repilado","sequence":"first","affiliation":[{"name":"Center for Congenital Heart Disease, Cardiology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Tobler","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Greutmann","sequence":"additional","affiliation":[{"name":"University Heart Centre Zurich, Department of Cardiology, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith","family":"Bouchardy","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland"},{"name":"Service de Cardiologie, University Hospital of Geneva, Geneve, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magalie","family":"Ladouceur","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Disease Unit, Centre de R\u00e9f\u00e9rence des Malformations Cardiaques Cong\u00e9nitales Complexes, M3C, Inserm U970, Paris Centre de Recherche Cardiovasculaire, H\u00f4pital Europeen Georges-Pompidou P\u00f4le Cardio-vasculaire R\u00e9nal M\u00e9tabolique, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5821-4501","authenticated-orcid":false,"given":"Laura","family":"Dos-Subira","sequence":"additional","affiliation":[{"name":"Unitat Integrada de Cardiopaties Cong\u00e8nites de l'Adolescent i l'Adult, Vall d'Hebron-Sant Pau, Vall d'Hebron University Hospital. Vall d'Hebron Barcelona Hospital Campus and CIBERCV, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2115-5047","authenticated-orcid":false,"given":"Pastora","family":"Gallego","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Disease Unit, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Virgen del Rocio University Hospital Cardiology and Cardiovascular Surgery Service, Sevilla, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harald","family":"Gabriel","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Disease Centre, Medical University of Vienna, Wien, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berto","family":"Bouma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4006-8929","authenticated-orcid":false,"given":"Markus","family":"Schwerzmann","sequence":"additional","affiliation":[{"name":"Center for Congenital Heart Disease, Cardiology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,4,21]]},"reference":[{"key":"2025081710350591000_8.1.e001455.1","unstructured":"Control ECfDPa . COVID-19 situation update for the EU\/EEA and the UK, as of 20, 2020. Available: https:\/\/www.ecdc.europa.eu\/en\/cases-2019-ncov-eueea [Accessed 20 Jun 2020]."},{"key":"2025081710350591000_8.1.e001455.2","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.recesp.2019.09.007","article-title":"Adult congenital heart disease in Spain: health care structure and activity, and clinical characteristics","volume":"73","author":"Oliver Ruiz","year":"2020","journal-title":"Rev Esp Cardiol"},{"key":"2025081710350591000_8.1.e001455.3","doi-asserted-by":"crossref","DOI":"10.4414\/smw.2017.14519","article-title":"Swiss Adult Congenital HEart disease Registry (SACHER) - rationale, design and first results","volume":"147","author":"Tobler","year":"2017","journal-title":"Swiss Med Wkly"},{"key":"2025081710350591000_8.1.e001455.4","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12201"},{"key":"2025081710350591000_8.1.e001455.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017202"},{"key":"2025081710350591000_8.1.e001455.6","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2020-317258"},{"key":"2025081710350591000_8.1.e001455.7","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.017224","article-title":"Coronavirus disease 2019 (COVID-19) pandemic implications in pediatric and adult congenital heart disease","volume":"9","author":"Alsaied","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2025081710350591000_8.1.e001455.8","doi-asserted-by":"crossref","unstructured":"Diller G-P , Gatzoulis MA , Broberg CS , et al . Coronavirus disease 2019 in adults with congenital heart disease: a position paper from the ESC Working group of adult congenital heart disease, and the International Society for adult congenital heart disease. Eur Heart J 2020;323.doi:10.1093\/eurheartj\/ehaa960","DOI":"10.1093\/eurheartj\/ehaa960"},{"key":"2025081710350591000_8.1.e001455.9","unstructured":"Oxford Centre for Evidence-Based Medicine: Levels of Evidence, March 2009. Available: https:\/\/www.cebm.ox.ac.uk\/resources\/levels-of-evidence\/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2020-001455","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:35:13Z","timestamp":1755452113000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2020-001455"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,4,21]]},"published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1136\/openhrt-2020-001455"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2020-001455","relation":{},"ISSN":["2053-3624"],"issn-type":[{"type":"electronic","value":"2053-3624"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}