TY - JOUR T1 - Perception is not reality when risk stratifying adults with congenital heart disease for COVID-19 JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2021-001660 VL - 8 IS - 1 SP - e001660 AU - Su Yuan AU - Erwin Oechslin Y1 - 2021/05/01 UR - http://openheart.bmj.com/content/8/1/e001660.abstract N2 - COVID-19 swept the world by surprise after December 2019. Its human, psychosocial and economical toll has been high, while the emergence of variants from the UK, South Africa and Brazil has delayed our hope for an early end to this pandemic through widespread vaccination. Patients with congenital heart disease (CHD) were considered to be particularly vulnerable to infection due to the cardiovascular and systemic sequelae of their underlying complex conditions and fragile pathophysiology, as well as the higher morbidity and mortality seen in non-CHD patients with cardiovascular disease.1 The European Society of Cardiology Working Group of Adult Congenital Heart Disease (ACHD) and the International Society for Adult Congenital Heart Disease published an early position statement that recommended risk stratifying ACHD patients using a combination of underlying anatomy and current physiology.2In this issue of Open Heart, Ruperti-Repilado et al surveyed 24 ACHD experts at 23 European centres to determine their perceived risk factors for adverse outcomes after COVID-19 infection, prior to available real-world data and in comparison to risk factors highlighted by the European Society of Cardiology and International Society for Adult Congenital Heart Disease position paper.3 Participants selected general and ACHD-specific risk factors for poor outcomes and estimated the overall risk for each of seven case scenarios. This study was part of the European collaboration for Prospective Outcome research in Congenital Heart disease (EPOCH), which recently published their results on the independent predictors of death or severe COVID-19 infection in CHD patients.4Importantly but unsurprisingly, most clinicians (82%) felt that ACHD patients were not equally at risk. This likely reflects the variability that exists in patients’ anatomy and residual sequelae, partly as a consequence of the decades of increasing surgical and interventional expertise. More than 90% of experts felt that pulmonary arterial hypertension, cyanotic … ER -