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Multicenter Study
. 2023 Feb 1;6(2):e2255795.
doi: 10.1001/jamanetworkopen.2022.55795.

Assessment of Symptom, Disability, and Financial Trajectories in Patients Hospitalized for COVID-19 at 6 Months

Andrew J Admon  1   2   3   4 , Theodore J Iwashyna  1   3   4   5   6 , Lee A Kamphuis  3 , Stephanie J Gundel  7 , Sarina K Sahetya  8 , Ithan D Peltan  9   10 , Steven Y Chang  11 , Jin H Han  12   13 , Kelly C Vranas  14   15 , Kirby P Mayer  16 , Aluko A Hope  17 , Sarah E Jolley  18 , Ellen Caldwell  19 , Max L Monahan  6   20 , Katrina Hauschildt  6   21 , Samuel M Brown  9   10 , Neil R Aggarwal  18 , B Taylor Thompson  21 , Catherine L Hough  22   23 ; National Heart, Lung, and Blood Institute PETAL Network
Collaborators, Affiliations
Multicenter Study

Assessment of Symptom, Disability, and Financial Trajectories in Patients Hospitalized for COVID-19 at 6 Months

Andrew J Admon et al. JAMA Netw Open. .

Abstract

Importance: Individuals who survived COVID-19 often report persistent symptoms, disabilities, and financial consequences. However, national longitudinal estimates of symptom burden remain limited.

Objective: To measure the incidence and changes over time in symptoms, disability, and financial status after COVID-19-related hospitalization.

Design, setting, and participants: A national US multicenter prospective cohort study with 1-, 3-, and 6-month postdischarge visits was conducted at 44 sites participating in the National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Network's Biology and Longitudinal Epidemiology: COVID-19 Observational (BLUE CORAL) study. Participants included hospitalized English- or Spanish-speaking adults without severe prehospitalization disabilities or cognitive impairment. Participants were enrolled between August 24, 2020, and July 20, 2021, with follow-up occurring through March 30, 2022.

Exposure: Hospitalization for COVID-19 as identified with a positive SARS-CoV-2 molecular test.

Main outcomes and measures: New or worsened cardiopulmonary symptoms, financial problems, functional impairments, perceived return to baseline health, and quality of life. Logistic regression was used to identify factors associated with new cardiopulmonary symptoms or financial problems at 6 months.

Results: A total of 825 adults (444 [54.0%] were male, and 379 [46.0%] were female) met eligibility criteria and completed at least 1 follow-up survey. Median age was 56 (IQR, 43-66) years; 253 (30.7%) participants were Hispanic, 145 (17.6%) were non-Hispanic Black, and 360 (43.6%) were non-Hispanic White. Symptoms, disabilities, and financial problems remained highly prevalent among hospitalization survivors at month 6. Rates increased between months 1 and 6 for cardiopulmonary symptoms (from 67.3% to 75.4%; P = .001) and fatigue (from 40.7% to 50.8%; P < .001). Decreases were noted over the same interval for prevalent financial problems (from 66.1% to 56.4%; P < .001) and functional limitations (from 55.3% to 47.3%; P = .004). Participants not reporting problems at month 1 often reported new symptoms (60.0%), financial problems (23.7%), disabilities (23.8%), or fatigue (41.4%) at month 6.

Conclusions and relevance: The findings of this cohort study of people discharged after COVID-19 hospitalization suggest that recovery in symptoms, functional status, and fatigue was limited at 6 months, and some participants reported new problems 6 months after hospital discharge.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Admon reported receiving grants from the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study. Dr Iwashyna reported receiving grants from the NIH during the conduct of the study. Ms Gundel reported receiving grants from the NIH during the conduct of the study and grants from the NIH outside the submitted work. Dr Sahetya reported receiving grants from the NIH NHLBI outside the submitted work. Dr Peltan reported receiving grants from the NIH NHLBI during the conduct of the study and grants from Janssen and other from Regeneron (payment to institution) outside the submitted work. Dr Chang reported receiving consulting fees from PureTech Health, consulting fees from Kiniksa Pharmaceuticals, and speaker’s fees from La Jolla Pharmaceuticals outside the submitted work. Dr Mayer reported receiving grants from the National Institute of Arthritis and Musculoskeletal and Skin Disease of the NIH under award K23AR079583 during the conduct of the study. Dr Hope reported receiving grants from the NHLBI during the conduct of the study; personal fees from the American Association of Critical Care Nurses for being coeditor-in-chief of the American Journal of Critical Care outside the submitted work. Dr Brown reported receiving grants from the NHLBI during the conduct of the study and personal fees from Hamilton Ventilators for data safety and monitoring board chair outside the submitted work. Dr Aggarwal reported receiving grants from the NIH outside the submitted work. Dr Thompson reported receiving grants from the NHLBI during the conduct of the study and personal fees from Bayer, Novartis, and Genentech outside the submitted work. Dr Hough reported receiving grants from the NIH during the conduct of the study and grants from the American Lung Association and NIH outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Trajectories in ADL and IADL Impairment Over Time
Alluvial diagram displaying the proportion of respondents with activities of daily living (ADL) and instrumental activities of daily living (IADL) impairments at each time point (vertical bars) and changes in responses over time (horizontal lines). A total of 472 respondents provided ADL and IADL information during all 3 surveys. Bar and line thicknesses are proportional to the number of patients represented by the relevant category (vertical bar) or change (horizontal line).
Figure 2.
Figure 2.. Self-reported Quality of Life Over Time, as Measured Using the European Quality of Life 5-Dimension Scale
Responses stratified by time point and quality of life domain: anxiety and/or depression (A), mobility (B), pain and/or discomfort (C), self-care (D), and usual activities (E).
See this image and copyright information in PMC

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