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Short-term outpatient follow-up of COVID-19 patients: A multidisciplinary approach
M A de Graaf1, M L Antoni1, M M Ter Kuile2
1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands.
Insights
Post-COVID-19 patients often experience functional limitations and cardiopulmonary issues, with Intensive Care Unit (ICU) survivors showing reduced lung function. Psychological distress was common across all patients.
Area of Science:
- Cardiology
- Pulmonology
- Psychiatry
Background:
- Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage, and psychological distress.
- Limited data exists on the burden of these sequelae and follow-up recommendations.
- This study evaluates cardiopulmonary function and psychological impairment post-hospitalization for COVID-19.
Purpose of the Study:
- To assess the prevalence and nature of cardiopulmonary dysfunction and psychological impairment in patients after COVID-19 hospitalization.
- To compare outcomes between patients admitted to the general ward versus the Intensive Care Unit (ICU).
- To investigate the relationship between functional status and post-COVID-19 sequelae.
Main Methods:
- Outpatient evaluation 6 weeks post-discharge.
- Cardiopulmonary assessment using echocardiography, 24-hour ECG monitoring, and pulmonary function tests.
- Psychological assessment via questionnaires and clinical interviews.
Main Results:
- 62% of patients presented with New York Heart Association class II-III symptoms.
- Left ventricular function was preserved in 78% of patients.
- ICU patients exhibited significantly lower diffusion capacity and lung volumes (FEV1, FVC).
- Rates of depression (17%), anxiety (5%), and PTSD (10%) were similar between ICU and non-ICU groups.
Conclusions:
- Most COVID-19 survivors experience functional limitations, notably dyspnea on exertion, potentially linked to reduced diffusing capacity of the lungs for carbon monoxide (DLCOc).
- Pulmonary fibrosis is a potential cause requiring long-term investigation.
- Factors like mechanical ventilation, deconditioning, and pulmonary embolism may contribute to persistent issues.
Background:
Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there are no clear recommendations for follow-up of COVID-19 patients.In this multi-disciplinary evaluation, cardiopulmonary function and psychological impairment after hospitalization for COVID-19 are mapped.
Methods:
We evaluated patients at our outpatient clinic 6 weeks after discharge. Cardiopulmonary function was measured by echocardiography, 24-hours ECG monitoring and pulmonary function testing. Psychological adjustment was measured using questionnaires and semi-structured clinical interviews. A comparison was made between patients admitted to the general ward and Intensive care unit (ICU), and between patients with a high versus low functional status.
Findings:
Eighty-one patients were included of whom 34 (41%) had been admitted to the ICU. New York Heart Association class II-III was present in 62% of the patients. Left ventricular function was normal in 78% of patients. ICU patients had a lower diffusion capacity (mean difference 12,5% P = 0.01), lower forced expiratory volume in one second and forced vital capacity (mean difference 14.9%; P<0.001; 15.4%; P<0.001; respectively). Risk of depression, anxiety and PTSD were 17%, 5% and 10% respectively and similar for both ICU and non-ICU patients.
Interpretation:
Overall, most patients suffered from functional limitations. Dyspnea on exertion was most frequently reported, possibly related to decreased DLCOc. This could be caused by pulmonary fibrosis, which should be investigated in long-term follow-up. In addition, mechanical ventilation, deconditioning, or pulmonary embolism may play an important role.
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