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Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325
Melissa Heightman1, Jai Prashar1,2, Toby E Hillman1
1University College London Hospitals NHS Foundation Trust, London, UK.
Insights
Post-COVID-19 complications affect many, with significant ongoing healthcare needs. Further research and patient-centered care are crucial for managing long COVID symptoms and improving recovery.
Area of Science:
- Medical Research
- Public Health
- Clinical Services
Background:
- Post-COVID-19 complications present complex challenges for healthcare systems.
- Characterizing and managing these conditions are vital for policy and response planning.
Purpose of the Study:
- To describe the 12-month experience of the first dedicated UK post-COVID-19 clinical service.
- To analyze demographics, symptoms, and recovery of patients referred via different routes (hospitalized, non-hospitalized, emergency department).
Main Methods:
- An observational analysis of 1325 individuals assessed between April 2020 and April 2021.
- Comparison of patient groups based on referral route: post-hospitalized (PH), non-hospitalized (NH), and post-emergency department (PED).
- Multivariable logistic regression used to assess factors associated with poor recovery or return to work.
Main Results:
- The non-hospitalized (NH) group was younger, more likely female, less likely ethnic minority, and seen later after symptom onset compared to PH and PED groups.
- Breathlessness and fatigue were common symptoms across all groups, particularly in NH patients.
- Hospitalized patients showed higher rates of pulmonary emboli, lung abnormalities, and organ impairment. Over half reported suboptimal health, with less than half returning to full-time work.
Conclusions:
- Post-COVID-19 symptoms significantly impact both hospitalized and non-hospitalized patients, leading to substantial healthcare needs.
- There is an urgent requirement for clinical trials of interventions and patient-centered pathways for diagnosis and treatment.
Introduction:
Post-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients.
Methods:
In a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression.
Results:
1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6-52.8) years vs 58.3 (47.0-67.7) years and 48.5 (39.4-55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118-298) days, 69 (51-111) days and 76 (55-128) days; all p<0.0001). All groups had similar rates of onward specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were more likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). Hospitalised patients had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 716 (54.0%) individuals reported <75% optimal health (median 70%, IQR 55%-85%). Less than half of employed individuals could return to work full time at first assessment.
Conclusion:
Post-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.
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