I am a pediatric cardiologist and have cared for children with heart disease for the past three decades. In addition, I have an educational background in business and finance as well as healthcare administration and global health – I gained a Masters Degree in Public Health from UCLA and taught Global Health there after I completed the program.
“You can have data without information, but you cannot have information without data.”
Daniel Keys Moran, American computer programmer and science fiction writer
This work from our pediatric institution, the Children’s Health of Orange County (CHOC), ushers in the era of big data from large, multi center, electronic health records databases and its ability to answer clinical queries in a relatively short time. This project came from a simple question we posed that emanated from clinical practice: are children with a prior cardiac event (arrest, surgery, etc) at higher risk if infected with COVID-19?
The large database from an EHR vendor revealed a relatively large number of children that fulfilled the criteria: COVID-19 infection, cardiac arrest, cardiogenic shock, heart surgery, cardiopulmonary disease, heart failure, etc. Conventional single or few center studies would not only yield relatively low numbers of patients (usually hundreds or thousands) but usually take months, if not years, for a full conclusion. This study was not only large in number of patients (close to 200,000) but also relatively expedient with the answer to the clinical query. A random intercept (mixed effects) logistic regression model was used to assess the associations. The publication was by far the most time-consuming step of the workflow but the answer to our original question was answered within weeks.
As expected, any prior cardiac cardiovascular condition was associated with an increased risk of severe COVID-19 disease, and the odds ratio was 3.04 with prior heart surgery and even 1.45 with simple biventricular defects. These findings were immediately helpful for anticipatory guidance and vaccination recommendations for families with children with congenital heart disease in the pediatric cardiology clinic setting. Work of this nature in the future will need to be even more precise for any child or patient in terms of prediction of the risk of any infection as well as real-time to answer these clinical queries with expediency.
Read the full paper here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792374
