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. 2021 Nov;8(1):e001041.
doi: 10.1136/bmjresp-2021-001041.

Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325 individuals

Melissa Heightman  1 , Jai Prashar  1   2 , Toby E Hillman  1 , Michael Marks  1   3 , Rebecca Livingston  1 , Heidi A Ridsdale  4 , Robert Bell  1   2 , Michael Zandi  1 , Patricia McNamara  1 , Alisha Chauhan  1 , Emma Denneny  1   2 , Ronan Astin  1 , Helen Purcell  1 , Emily Attree  5 , Lyth Hishmeh  6 , Gordon Prescott  7 , Rebecca Evans  1   2 , Puja Mehta  1   2 , Ewen Brennan  1 , Jeremy S Brown  1   2 , Joanna Porter  1   2 , Sarah Logan  1 , Emma Wall  1   2   8 , Hakim-Moulay Dehbi  2 , Stephen Cone  1 , Amitava Banerjee  9   2   10
Affiliations

Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325 individuals

Melissa Heightman et al. BMJ Open Respir Res. 2021 Nov.

Erratum in

Abstract

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.

Keywords: COVID-19; clinical epidemiology.

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Conflict of interest statement

Competing interests: AB has received research grants from AstraZeneca, unrelated to this work. All other authors report no relevant conflicts of interest.

Figures

Figure 1
Figure 1
Post-COVID-19 assessment in the context of the pandemic. CDC, Centers for Disease Control and Prevention; ISARIC 4C, International Severe Acute Respiratory and emerging Infection Consortium (Coronavirus Clinical Characterisation Consortium); NHS, National Health Service; NIHR, National Institute of Health Research; PCS, Post COVID Syndrome; PHE, Public Health England; RECOVERY, Randomised Evaluation of COVID-19 Therapy; UCLH, University College London Hospitals NHS Foundation Trust.
Figure 2
Figure 2
Population undergoing assessment at the post-COVID-19 assessment clinic. CXR, Chest X-Ray; GP, General Practice; ICS, Integrated Care System; UCLH, University College London Hospitals NHS Foundation Trust.
Figure 3
Figure 3
Co-occurrence of symptoms at first assessment of 1325 individuals referred to the post-COVID-19 assessment clinic. ED, emergency department.
See this image and copyright information in PMC

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