Abstract 4370357: Effect of COVID-19 on Pediatric Population and Congenital Heart Disease: A Comprehensive Examination of Outcomes, Vaccination Effectiveness, and Healthcare Inequalities

Background: Children with congenital heart disease (CHD) represent a vulnerable population with heightened susceptibility to respiratory infections. However, comprehensive data characterizing COVID-19 outcomes, vaccination benefits, and healthcare disparities in pediatric CHD patients remain limited. This study synthesizes multicenter evidence to evaluate clinical outcomes, vaccination effectiveness, and healthcare inequities affecting pediatric CHD patients during the COVID-19 pandemic. Methods: We conducted a comprehensive analysis integrating data from four primary sources: (1) an international editorial review examining pandemic impacts on CHD care delivery, (2) analysis of national hospitalization data comparing CHD patients with non-CHD pediatric counterparts, (3) a large-scale population-based study evaluating vaccination outcomes in CHD patients, and (4) a multicenter pediatric COVID-19 case series including complex CHD subgroups. Clinical outcomes, vaccination effectiveness, and healthcare access disparities in the Low and Middle Income Countries (LMIC) were systematically analyzed. Results: Analysis of pediatric CHD patients (median age 3 years) revealed significantly higher COVID-19 complications versus non-CHD controls: cardiovascular (tachyarrhythmias aOR 4.1, 95%CI 2.9-5.8), respiratory (mechanical ventilation RR 3.2, 2.1-4.9), and systemic (acute kidney injury aOR 3.4, 2.2-5.3; all p<0.001). While mortality remained low (CHD 1.2% vs non-CHD 0.8%, p=0.21), children <3 years accounted for 40% of cases and 78% of critical illnesses (p<0.001), with 70% showing bilateral lung involvement. Complex CHD anatomy conferred 4.3-fold higher ICU risk (95%CI 2.7-6.8). Vaccination reduced hospitalizations by 87% (aOR 0.13, 0.08-0.22), though disparities persisted with 68% of LMIC patients experiencing delayed cardiac surgeries. Conclusions: While most pediatric COVID-19 cases demonstrate favorable outcomes, children with CHD—particularly infants and those with complex cardiac anatomy—face substantially increased complication risks. COVID-19 vaccination provides significant protection for CHD patients but does not eliminate outcome disparities compared to healthy children. The pandemic revealed critical inequities in CHD care access, highlighting the urgent need for targeted interventions to protect high-risk pediatric populations and address healthcare disparities in resource-limited regions.