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Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort study

Hamish J C McAuley et al. EClinicalMedicine. .

Abstract

Background: The scale of COVID-19 and its well documented long-term sequelae support a need to understand long-term outcomes including frailty.

Methods: This prospective cohort study recruited adults who had survived hospitalisation with clinically diagnosed COVID-19 across 35 sites in the UK (PHOSP-COVID). The burden of frailty was objectively measured using Fried's Frailty Phenotype (FFP). The primary outcome was the prevalence of each FFP group-robust (no FFP criteria), pre-frail (one or two FFP criteria) and frail (three or more FFP criteria)-at 5 months and 1 year after discharge from hospital. For inclusion in the primary analysis, participants required complete outcome data for three of the five FFP criteria. Longitudinal changes across frailty domains are reported at 5 months and 1 year post-hospitalisation, along with risk factors for frailty status. Patient-perceived recovery and health-related quality of life (HRQoL) were retrospectively rated for pre-COVID-19 and prospectively rated at the 5 month and 1 year visits. This study is registered with ISRCTN, number ISRCTN10980107.

Findings: Between March 5, 2020, and March 31, 2021, 2419 participants were enrolled with FFP data. Mean age was 57.9 (SD 12.6) years, 933 (38.6%) were female, and 429 (17.7%) had received invasive mechanical ventilation. 1785 had measures at both timepoints, of which 240 (13.4%), 1138 (63.8%) and 407 (22.8%) were frail, pre-frail and robust, respectively, at 5 months compared with 123 (6.9%), 1046 (58.6%) and 616 (34.5%) at 1 year. Factors associated with pre-frailty or frailty were invasive mechanical ventilation, older age, female sex, and greater social deprivation. Frail participants had a larger reduction in HRQoL compared with before their COVID-19 illness and were less likely to describe themselves as recovered.

Interpretation: Physical frailty and pre-frailty are common following hospitalisation with COVID-19. Improvement in frailty was seen between 5 and 12 months although two-thirds of the population remained pre-frail or frail. This suggests comprehensive assessment and interventions targeting pre-frailty and frailty beyond the initial illness are required.

Funding: UK Research and Innovation and National Institute for Health Research.

Keywords: COVID-19; Fried's frailty phenotype; Hospitalisation; Long-COVID; Physical frailty.

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Conflict of interest statement

RAE declares speaker fees or support from Boeringher Ingelheim and 10.13039/100019719Chiesi as well as their role as ERS Group 01.02 Pulmonary Rehabilitation Secretary. CEBo and AG declare support from 10.13039/501100020624NIHR Nottingham BRC and Nottingham university Hospitals Trust R&I and Nottingham Hospitals Charity. CEB declares grants and consultancy paid to institution from GSK, AZ, 10.13039/100004339Sanofi, 10.13039/100001003Boeringher Ingelheim, Chiesi, 10.13039/100004336Novartis, 10.13039/100004337Roche, 10.13039/100004328Genentech, Mologic, 4DPharma outside of this work. JDC declares grants from 10.13039/100004337Roche, Insmed, 10.13039/100001003Boehringer Ingelheim, 10.13039/100004336Novartis, GSK, 10.13039/100005564Gilead Sciences and 10.13039/501100016387Grifols as well as consulting fees from 10.13039/100004325Astrazeneca, Insmed, 10.13039/100001003Boehringer Ingelheim, Janssen, Chiesi, 10.13039/100004336Novartis, Grifols, Zambon, Pfizer and GSK outside of this work. AH declares institutional and individual support from the NIHR Manchester BRC as well as their role as Deputy Chair NIHR Translational Research Collaboration. WD-CM declares grants or contracts from National Institute for Health Research, Asthma + Lung UK and NHSX as well as payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Mundipharma, 10.13039/100004336Novartis and European Conference and Incentive Services and participation on a Data Safety Monitoring Board or Advisory Board for Jazz Pharmaceuticals and receipt of equipment, materials, drugs, medical writing, gifts or other services from GSK for funds for blood analysis outside of this work. JKQ declares grants paid to institution from the Medical Research Council, HDR UK, GSK, Bayer, 10.13039/100001003Boehringer Ingelheim, Asthma + Lung UK, 10.13039/100019719Chiesi and 10.13039/100004325AstraZeneca as well as advisory bord participation or speaking fees from 10.13039/100004330GlaxoSmithKline, 10.13039/100001003Boehringer Ingelheim, 10.13039/100004325AstraZeneca, 10.13039/100019719Chiesi, Teva, Insmed and 10.13039/100004326Bayer. BR declares consulting fees from Axcella Therapeutics outside of this work. SJS declares grants from the NIHR programme grant (NIHR 202020) as an NIHR Senior Investigator, the Wellcome Doctoral Training Programme, HTA Project Grant (NIHR: 131015), NIHR DHSC/UKRI COVID-19 Rapid Response Initiative, NIHR Global Research Group (NIHR 17/63/20) and Actegy Limited, honoraria paid by GSK, Ministry of Justice, CIPLA and Sherbourne Gibbs for presentations, participation on the NICE Expert Adviser Panel - Long COVID and Wales Long COVID Advisory Board (expired) and a role as ATS Pulmonary Rehabilitation Assembly Chair, Clinical Lead RCP Pulmonary Rehabilitation Accreditation Scheme and Clinical Lead NACAP Audit for Pulmonary Rehabilitation. LVW declares additional support from GSK and 10.13039/501100000362Asthma + Lung UK (Professorship (C17-1)) relating to this work as well as research funding from Orion Pharma and GSK, research collaboration contracts from Genentech and 10.13039/100004325AstraZeneca, consulting fees paid to institution from Galapagos for participation in an advisory board, support for travel from Genentech and their role as Associate Editor for European Respiratory Journal outside of this work. JW declares grants from the 10.13039/501100009130NIHR programme development grant and 10.13039/100015544King’s College Hospital Charity as well as participation on the trial steering group for “Falls in Care Homes (FinCH)” and programme steering group member for “Promoting Activity, Independence and Stability in Early Dementia (PrAISED) research programme” as their role as Clinical lead for national audit of inpatient falls (Royal College of Physicians) outside of this work. NJG declares grants or contracts from the NIHR, GSK and MRC, consulting fees paid to institution from Genentech, lecture fees from 10.13039/100004325AstraZeneca and 10.13039/100001003Boehringer Ingelheim as well as both lecture fees and support for travel from 10.13039/100019719Chiesi outside of this work. HJCM, ABD, OE, PLG, VCH, EMH, L-PH, LH-W, CJJ, OCL, NIL, MM, DP, KP, MR, RMS, MSe, AShi, ASi, MSt, ALT, CW, MDW and JML declare no competing interests.

Figures

Fig. 1
Fig. 1
Study profile. (a) The number of participants included and reasons for exclusion. (b) Frailty domain proportions at 5 months. (c) Frailty domain proportions at 5 months and 1 year, with movements between frailty domains shown.
Fig. 2
Fig. 2
Risk factors for the presence of frailty at (a) 5 months and (b) 1 year following hospitalisation for COVID-19. Data presented are odds ratios and 95% confidence intervals using multivariable ordinal regression. Numerical values are shown in Supplementary Table ST5.
Fig. 3
Fig. 3
Frailty status. (a) Number of participants meeting criteria of each FFP sub-domain in those classified as pre-frail at 5 months and 1 year. (b) Number of participants meeting criteria of each FFP sub-domain in those classified as frail at 5 months and 1 year. (c) Percent fall in participants meeting criteria for each FFP sub-domain among those who improved from frail to either pre-frail or robust between 5 months and 1 year (n = 176). (d) Percent fall in participants meeting criteria for each FFP sub-domain among those who improved from pre-frail to robust between 5 months and 1 year (n = 358). (e) Percent increase in participants meeting criteria for each FFP sub-domain among those who progressed from pre-frail to frail between 5 months and 1 year (n = 54). (f) Percent increase in participants meeting criteria for each FFP sub-domain among those who progressed from robust to either pre-frail or frail between 5 months and 1 year (n = 173). FFP=Fried's Frailty Phenotype.
Fig. 4
Fig. 4
HQQoL and recovery. (a) Change in HRQoL (assessed via EQ5D-5L Utility Index) from pre-COVID to 5 month and 1 year visits by frailty status at 1 year. ∗Change from baseline to 5 months greater in the frail group than robust group p = 0.004. (b) Self-reported recovery at 1 year visit, by frailty status at 1 year. HRQoL = health-related quality of life.
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