BMJ Open Respiratory Research (Jan 2021)

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

  • Amitava Banerjee,
  • Michael Marks,
  • Sarah Logan,
  • Jeremy S Brown,
  • Puja Mehta,
  • Gordon Prescott,
  • Rebecca Evans,
  • Robert Bell,
  • Michael Zandi,
  • Joanna Porter,
  • Emily Attree,
  • Melissa Heightman,
  • Toby E Hillman,
  • Alisha Chauhan,
  • Lyth Hishmeh,
  • Hakim-Moulay Dehbi,
  • Heidi A Ridsdale,
  • Ronan Astin,
  • Emma Wall,
  • Ewen Brennan,
  • Patricia McNamara,
  • Jai Prashar,
  • Rebecca Livingston,
  • Emma Denneny,
  • Helen Purcell,
  • Stephen Cone,
  • Kay Roy

DOI
https://doi.org/10.1136/bmjresp-2021-001041
Journal volume & issue
Vol. 8, no. 1

Abstract

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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.