Symptoms and quality of life at 1-year follow up of patients discharged after an acute COVID-19 episode
AIM OF THE STUDY: Patients surviving COVID-19 have been described as being at risk of developing sequelae. We aimed to investigate and elicit persistent symptoms, emotional status and quality-of-life in patients discharged after an acute COVID-19 episode.
METHODS: Patient-reported outcome measures were collected during a telephone interview 30 days and 1 year after discharge. Patients' general health status was evaluated using questions based on their symptoms, emotional status was assessed using the items 9 to 12 of the HeartQoL questionnaire and quality of life was assessed at 1 year through the EQ-5D-5L. In patients with a history of cardiovascular disease, all 14 items of the HeartQoL questionnaire were completed to derive the HeartQoL global score.
RESULTS: Among 687 patients who survived after being hospitalised for COVID-19 at the University Hospitals of Geneva between 26 February and 26 April 2020, 184 (27%) and 165 (24%), respectively, participated in the follow-up at 30 days and 1 year. Of these 184 participants, 62% were male, median age was 58 years and 21% had a past medical history of cardiovascular disease. At one month after discharge, 61% (113/184) of patients presented fatigue and 28% (52/184) dyspnoea. One year after discharge, the main complaints were persistent fatigue in 27% (45/165) of patients, neurological problems in 17% (28/165) and dyspnoea in 14% (23/165). Eight percent (14/184) of patients declared being significantly worried 1 month after discharge and 5% (9/184) feeling depressed. The number of patients reporting being significantly worried or depressed at 1 year was lower. Regarding the quality of life at 1 year, the median EQ-5D-5L visual analogue scale score was 80 (interquartile range 70–90).
CONCLUSIONS: Approximately half of patients reported some symptoms 1 year after discharge following an acute episode of COVID-19. The predominant symptom was persistent fatigue both at 1-month and at 1-year follow-up. Emotional status and quality of life appeared satisfactory.
ClinicalTrials.gov number: NCT04384029
- www.worldometers.info/coronavirus/?zarsrc=130. Worldometer. COVID-19 Coronavirus Pandemic 2020.
- Liu C, Ye L, Xia R, Zheng X, Yuan C, Wang Z, et al. Chest Computed Tomography and Clinical Follow-Up of Discharged Patients with COVID-19 in Wenzhou City, Zhejiang, China. Ann Am Thorac Soc. 2020 Oct;17(10):1231–7. https://doi.org/10.1513/AnnalsATS.202004-324OC
- El Keshky ME, Basyouni SS, Al Sabban AM. Getting Through COVID-19: The Pandemic’s Impact on the Psychology of Sustainability, Quality of Life, and the Global Economy - A Systematic Review. Front Psychol. 2020 Nov;11:585897. https://doi.org/10.3389/fpsyg.2020.585897
- Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020 Jun;55(6):2001217. https://doi.org/10.1183/13993003.01217-2020
- Xiong TY, Redwood S, Prendergast B, Chen M. Coronaviruses and the cardiovascular system: acute and long-term implications. Eur Heart J. 2020 May;41(19):1798–800. https://doi.org/10.1093/eurheartj/ehaa231
- Chen KY, Li T, Gong FH, Zhang JS, Li XK. Predictors of Health-Related Quality of Life and Influencing Factors for COVID-19 Patients, a Follow-Up at One Month. Front Psychiatry. 2020 Jul;11:668. https://doi.org/10.3389/fpsyt.2020.00668
- The Lancet. Facing up to long COVID. Lancet. 2020 Dec;396(10266):1861. https://doi.org/10.1016/S0140-6736(20)32662-3
- https://www.who.int/publications/i/item/clinical-management-of-covid-19. WHO Guideline Development Group for Clinical Management of COVID-19. Clinical management of COVID-19. Interim guidance.
- Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul;37(27):2129–200. https://doi.org/10.1093/eurheartj/ehw128
- Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al.; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018 Oct;72(18):2231–64. https://doi.org/10.1016/j.jacc.2018.08.1038
- Oldridge N, Höfer S, McGee H, Conroy R, Doyle F, Saner H ; for the HeartQoL Project Investigators. The HeartQoL: part I. Development of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol. 2014 Jan;21(1):90–7. https://doi.org/10.1177/2047487312450544
- Oldridge N, Höfer S, McGee H, Conroy R, Doyle F, Saner H ; for the HeartQoL Project Investigators. The HeartQoL: part II. Validation of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol. 2014 Jan;21(1):98–106. https://doi.org/10.1177/2047487312450545
- Kristensen MS, Zwisler AD, Berg SK, Zangger G, Grønset CN, Risom SS, et al. Validating the HeartQoL questionnaire in patients with atrial fibrillation. Eur J Prev Cardiol. 2016 Sep;23(14):1496–503. https://doi.org/10.1177/2047487316638485
- Grønset CN, Thygesen LC, Berg SK, Zangger G, Kristensen MS, Sibilitz KL, et al. Measuring HRQoL following heart valve surgery: the HeartQoL questionnaire is a valid and reliable core heart disease instrument. Qual Life Res. 2019 May;28(5):1245–53. https://doi.org/10.1007/s11136-018-02098-1
- EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990 Dec;16(3):199–208. https://doi.org/10.1016/0168-8510(90)90421-9
- Brooks R. EuroQol: the current state of play. Health Policy. 1996 Jul;37(1):53–72. https://doi.org/10.1016/0168-8510(96)00822-6
- Janssen MF, Pickard AS, Golicki D, Gudex C, Niewada M, Scalone L, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2013 Sep;22(7):1717–27. https://doi.org/10.1007/s11136-012-0322-4
- Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2021 Feb;93(2):1013–22. https://doi.org/10.1002/jmv.26368
- Carfì A, Bernabei R, Landi F ; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug;324(6):603–5. https://doi.org/10.1001/jama.2020.12603
- Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One. 2020 Nov;15(11):e0240784. https://doi.org/10.1371/journal.pone.0240784
- Bansal AS, Bradley AS, Bishop KN, Kiani-Alikhan S, Ford B. Chronic fatigue syndrome, the immune system and viral infection. Brain Behav Immun. 2012 Jan;26(1):24–31. https://doi.org/10.1016/j.bbi.2011.06.016
- Natelson BH, Haghighi MH, Ponzio NM. Evidence for the presence of immune dysfunction in chronic fatigue syndrome. Clin Diagn Lab Immunol. 2002 Jul;9(4):747–52.
- Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther. 2020 Jun;12(1):69. https://doi.org/10.1186/s13195-020-00640-3
- Alemanno F, Houdayer E, Parma A, Spina A, Del Forno A, Scatolini A, et al. COVID-19 cognitive deficits after respiratory assistance in the subacute phase: A COVID-rehabilitation unit experience. PLoS One. 2021 Feb;16(2):e0246590. https://doi.org/10.1371/journal.pone.0246590
- Cao W, Zhang Y, Qian P. Corrrection: The Effect of Innovation-Driven Strategy on Green Economic Development in China-An Empirical Study of Smart Cities. Int. J. Environ. Res. Public Health 2019, 16(9), 1520. Int J Environ Res Public Health. 2020 May;17(10):E3380. https://doi.org/10.3390/ijerph17103380
- Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020 Dec;81(6):e4–6. https://doi.org/10.1016/j.jinf.2020.08.029
- De Smedt D, Clays E, Höfer S, Oldridge N, Kotseva K, Maggioni AP, et al. The use of HeartQoL in patients with coronary heart disease: association with risk factors and European reference values. The EUROASPIRE IV study of the European Society of Cardiology. Eur J Prev Cardiol. 2016 Jul;23(11):1174–86. https://doi.org/10.1177/2047487316631400
- Walle-Hansen MM, Ranhoff AH, Mellingsæter M, Wang-Hansen MS, Myrstad M. Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. BMC Geriatr. 2021 Mar;21(1):199. https://doi.org/10.1186/s12877-021-02140-x