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Abstract Background and Methods Heart transplant recipients (HTr) have a higher probability of suffer from severe coronavirus disease‐2019 (COVID‐19) in comparison to general population, but their risk has changed over the course of the pandemic in relation to various factors. We conducted a prospective study including all HTr at risk of COVID‐19 in a tertiary center between February 2020 and October 2022. The aim was to analyze how the prognosis (incidence of pneumonia and mortality) of COVID‐19 in HTr has evolved over time, contextualizing variants, vaccination, and other treatments. Results Of 308 HTr included, 124 got the infection (39.2%). COVID and non‐COVID HTr had similar baseline characteristics. COVID‐19 patients with pneumonia had a poorer prognosis than those with less severe presentations, with a higher rate of hospitalization (93.3 vs. 14.1%, p < .001) and death (41.0 vs. 1.2%, p < .001). Multivariate analysis identified age ≥60 years (odds ratio OR 3.65, 95% confidence interval CI 1.16–11.49, p = .027), and chronic kidney disease ≥3a (OR 4.95, 95% CI 1.39–17.54, p = .014) as predictors of pneumonia. Two‐dose vaccination (OR 0.20, CI 95% 0.05–0.72, p = .02) and early remdesivir administration (OR 0.17, CI 0.03–0.90, p = .037) were protective factors. Over the course of the pandemic considering three periods in the follow‐up (prevaccination February–December 2020, postvaccination January–December 2021, and post early remdesivir indication January–October 2022), we observed a reduction in pneumonia incidence from 62% to 19% ( p < .001); and mortality (from 23% to 4%, p < .001). Conclusions The prognosis of COVID‐19 in HTr has improved over time, likely due to vaccination and early administration of remdesivir. image
López‐Azor et al. (Tue,) studied this question.