Long-term cardiovascular health status and physical functioning of nonhospitalized patients with COVID-19 compared with non-COVID-19 controls

Abstract

Coronavirus disease 2019 (COVID-19) is reported to have long-term effects on cardiovascular health and physical functioning, even in the nonhospitalized population. The physiological mechanisms underlying these long-term consequences are however less well described. We compared cardiovascular risk factors, arterial stiffness, and physical functioning in nonhospitalized patients with COVID-19, at a median of 6 mo postinfection, versus age- and sex-matched controls. Cardiovascular risk was assessed using blood pressure and biomarker concentrations (amino-terminal pro-B-type-natriuretic-peptide, high-sensitive cardiac troponin I, C-reactive protein), and arterial stiffness was assessed using carotid-femoral pulse wave velocity. Physical functioning was evaluated using accelerometry, handgrip strength, gait speed and questionnaires on fatigue, perceived general health status, and health-related quality of life (hrQoL). We included 101 former patients with COVID-19 (aged 59 [interquartile range, 55-65] yr, 58% male) and 101 controls. At 175 [126-235] days postinfection, 32% of the COVID-19 group reported residual symptoms, notably fatigue, and 7% required post-COVID-19 care. We found no differences in blood pressure, biomarker concentrations, or arterial stiffness between both groups. Former patients with COVID-19 showed a higher handgrip strength (43 [33-52] vs. 38 [30-48] kg, P = 0.004) and less sleeping time (8.8 [7.7-9.4] vs. 9.8 [8.9-10.3] h/day, P < 0.001) and reported fatigue more often than controls. Accelerometry-based habitual physical activity levels, gait speed, perception of general health status, and hrQoL were not different between groups. In conclusion, one in three nonhospitalized patients with COVID-19 reports residual symptoms at a median of 6 mo postinfection, but we were unable to relate these symptoms to increases in cardiovascular risk factors, arterial stiffness, or physical dysfunction.NEW & NOTEWORTHY We examined cardiovascular and physical functioning outcomes in nonhospitalized patients with COVID-19, at a median of 6 mo postinfection. When compared with matched controls, minor differences in physical functioning were found, but objective measures of cardiovascular risk and arterial stiffness did not differ between groups. However, one in three former patients with COVID-19 reported residual symptoms, notably fatigue. Follow-up studies should investigate the origins of residual symptoms and their long-term consequences in former, nonhospitalized patients with COVID-19.

Keywords: COVID-19; cardiovascular health; long-term effects; nonhospitalized; physical functioning.

Figure 1.

Biomarker concentrations of high-sensitive cardiac troponin I (hs-cTnI; A), amino-terminal pro-B-type-natriuretic peptide (NT-proBNP; B), and C-reactive protein (CRP; C) in the COVID-19 (N = 94) and control (N = 101) groups. Each dot represents an individual data point, whereas the boxplots represent group statistics (Q1, median, Q3; whiskers extending up to 1.5 times the interquartile range). Dashed red lines indicate the upper reference limit (URL) and the limit of detection (LOD). Differences between groups were assessed with a Mann–Whitney U test.

Figure 2.

Arterial stiffness parameters expressed as carotid-femoral pulse wave velocity (cf-PWV, m/s; A), stiffness index β (dimensionless; B), and pressure strain elasticity epsilon (kPa; C) for the COVID-19 (N = 87) and control (N = 49) groups. Each dot represents an individual data point, whereas box plots represent group statistics (Q1, median, Q3; whiskers extending up to 1.5 times the interquartile range). Differences between groups were assessed with a Mann–Whitney U test.

Figure 3.

Habitual physical activity patterns expressed as sleeping time (A), sitting time (B), time spent in light-intensity physical activity (LIPA; C), and time spent in moderate-to-vigorous physical activity (MVPA; D) for the COVID-19 (N = 101) and control (N = 101) groups. Each dot represents an individual data point, whereas box plots represent group statistics (Q1, median, Q3; whiskers extending up to 1.5 times the interquartile range). Differences between groups were assessed with a Mann–Whitney U test for A, C, and D and an independent sample t test for B.

Figure 4.

Self-reported outcomes of the COVID-19 (N = 96) and control (N = 98) groups: level of fatigue (Fatigue Severity Scale), range 1–7, high score indicating a high level of fatigue (A), general health status [pooled Short Form 12 (SF-12) score], range 0%–100%, high score indicating a high level of general health status (B), and health-related quality of life (hrQoL; EQ-5D-5L), range 1–5, high score indicating a low hrQoL (C). Each dot represents an individual data point, whereas the box plot represents group statistics (Q1, median, Q3; whiskers extending up to 1.5 times the interquartile range). Differences between groups were assessed with a Fisher’s exact test for A and C and a Mann–Whitney U test for B.