Internal Medicine Resident University Of Saskatchewan Regina, Saskatchewan, Canada
Background: Adults with congenital heart disease (ACHD) face increased COVID‑19 morbidity and mortality due to anatomic and physiologic vulnerabilities. However, data on vaccine uptake, hesitancy, knowledge, attitudes, and patient–provider communication in this population are limited. We conducted a retrospective cross‑sectional survey of ACHD outpatients at a tertiary congenital heart clinic in Regina, Saskatchewan, to assess vaccination status, infection history, and health beliefs.
METHODS AND RESULTS: From January to March 2025, we contacted 408 ACHD outpatients aged ≥ 18 years via telephone or tablet to complete a 21‑item questionnaire based on the Health Belief Model. Forty‑two patients (10% response rate) have participated (mean age 42 ± 17 years; 43% female; 88% White). Fifty‑two percent were high‑school graduates; 60% worked > 30 hours/week; 31% were unemployed. We assessed four domains—practices, knowledge, attitudes, and hesitancy—and performed univariate comparisons (chi‑square or Fisher’s exact tests). In the practices domain, 83% received at least one COVID‑19 vaccine dose and 52% had completed three or more doses. Seventy‑four percent reported prior COVID infection, of whom 57% experienced mild to moderate symptoms. Only 5% recalled discussing the vaccination with their cardiologist versus 21% with their primary care provider. Knowledge gaps were notable: while all vaccinated respondents correctly identified full immunity timing, 50% were unsure when immunity was achieved; 7% believed it followed the first dose, 19% after the second, and 5% post‑infection (p < 0.001). Survey responses to 21 Likert‑scale statements showed that 69% agreed the COVID‑19 vaccine was important for health and 33% believed it had cardioprotective benefits. Yet only 52% felt safety evidence was sufficient, 47% worried about side effects, and 41% feared long‑term cardiac impacts. Additionally, 31% suspected pharmaceutical profit motives and 29% questioned rapid development and effectiveness. Univariate analysis revealed that concerns about side effects, doubts about effectiveness, preference for natural immunity, or uncertainty about long‑term benefits were associated with lower vaccination odds (p < 0.05), whereas beliefs in health importance and cardioprotection correlated with higher uptake (p < 0.05).
Conclusion: Perceptions of safety and efficacy strongly influence COVID‑19 vaccination among ACHD patients: concerns about side effects and doubts about effectiveness were associated with decreased uptake, while belief in the vaccine’s health benefits and cardioprotection were linked to higher uptake. Targeted communication addressing safety and cardiac benefits is crucial.
