Background Fatigue is a common symptom in hospitalized and non-hospitalized patients recovering from COVID-19, but no fatigue measurement scales or questions have been validated in these populations. The objective of this study was to perform validity assessments of the fatigue severity scale (FSS) and two single-item screening questions (SISQs) for fatigue in patients recovering from COVID-19. Methods We examined patients ≥ 28 days after their first SARS-CoV-2 infection who were hospitalized for their acute illness, as well as non-hospitalized patients referred for persistent symptoms. Patients completed questionnaires through 1 of 4 Post COVID-19 Recovery Clinics in British Columbia, Canada. Construct validity was assessed by comparing FSS scores to quality of life and depression measures. Two SISQs were evaluated based on the ability to classify fatigue (FSS score ≥ 4). Results Questionnaires were returned in 548 hospitalized and 546 non-hospitalized patients, with scores computable in 96.4% and 98.2% of patients respectively. Cronbach’s alpha was 0.96 in both groups. The mean ± SD FSS score was 4.4 ± 1.8 in the hospitalized and 5.2 ± 1.6 in the non-hospitalized group, with 62.5% hospitalized and 78.9% non-hospitalized patients classified as fatigued. Ceiling effects were 7.6% in the hospitalized and 16.1% in non-hospitalized patients. FSS scores negatively correlated with EQ-5D scores in both groups (Spearman’s rho − 0.6 in both hospitalized and non-hospitalized; p < 0.001) and were higher among patients with a positive PHQ-2 depression screen (5.4 vs. 4.0 in hospitalized and 5.9 vs. 4.9 in non-hospitalized; p < 0.001). An SISQ asking whether there was “fatigue present” had a sensitivity of 70.6% in hospitalized and 83.2% in non-hospitalized patients; the “always feeling tired” SISQ, had a sensitivity of 70.5% and 89.6% respectively. Conclusions Fatigue was common and severe in patients referred for post COVID-19 assessment. Overall, the FSS is suitable for measuring fatigue in these patients, as there was excellent data quality, strong internal consistency, and construct validity. However, ceiling effects may be a limitation in the non-hospitalized group. SISQs had good sensitivity for identifying clinically relevant fatigue in non-hospitalized patients but only moderate sensitivity in the hospitalized group, indicating that there were more false negatives.

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Introduction Several jurisdictions have adopted a more conservative approach to anemia in patients receiving dialysis amid safety concerns from target hemoglobin studies. It is largely unknown if this has contributed to a change in clinical outcomes. Methods A national registry was used to identify 35,945 adult patients who initiated and were maintained on dialysis for ≥90 days in Canada from January 2007 to December 2015. Outcomes were ascertained until March 2017 via linkage with hospital discharge diagnoses. Cox proportional hazards models were used to investigate the association between the era of dialysis initiation and the primary composite outcome (acute myocardial infarction [AMI], stroke, or mortality). Results The mean hemoglobin at dialysis initiation decreased from 102.9 g/l in 2007 to 95.5 g/l in 2015, corresponding with a higher prevalence of hemoglobin <80 g/l (8% to 17%) and a reduction in erythropoiesis stimulating agent (ESA) use (49% to 44%). After multivariable adjustment, Era 3 (2013–2015) was associated with an 8% relative risk reduction in the primary outcome compared with Era 1 (2007–2009) (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.88–0.96), a 10% relative reduction in mortality (HR 0.90, 95% CI 0.85–0.94) but no significant change in AMI or stroke. In a model without era, neither hemoglobin nor ESA use was an independent predictor of outcome. Conclusion There have been modest declines in average hemoglobin values and ESA use among incident dialysis patients in Canada with no change in major cardiovascular outcomes. Patient survival has improved over time, likely for reasons other than anemia management.

Aims The aim of this study was to determine the comparative effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in adults with atrial fibrillation (AF) by level of kidney function. Methods and results We pooled findings from 5 retrospective cohorts (2011–2018) across Australia and Canada of adults with; a new dispensation for a DOAC or warfarin, an AF diagnosis, and a measure of baseline estimated glomerular filtration rate (eGFR). The outcomes of interest, within 1 year from the cohort entry date, were: (1) the composite of all-cause death, first hospitalization for ischemic stroke, or transient ischaemic attack (effectiveness), and (2) first hospitalization for major bleeding defined as an intracranial, upper or lower gastrointestinal, or other bleeding (safety). Cox models were used to examine the association of a DOAC versus warfarin with outcomes, after 1:1 matching via a propensity score. Kidney function was categorized as eGFR ≥60, 45-59, 30-44, and &lt;30 mL/min/1.73m2. A total of 74,542 patients were included in the matched analysis. DOAC initiation was associated with greater or similar effectiveness compared to warfarin initiation across all eGFR categories (pooled HRs[95% CIs] for eGFR categories: 0.74[0.69-0.79], 0.76[0.54-1.07], 0.68[0.61-0.75] and 0.86[0.76-0.98]), respectively. DOAC initiation was associated with lower or similar risk of major bleeding than warfarin initiation (pooled HRs[95% CIs]: 0.75[0.65-0.86], 0.81[0.65-1.01], 0.82[0.66-1.02], and 0.71[0.52-0.99], respectively). Associations between DOAC initiation, compared with warfarin initiation, and study outcomes were not modified by eGFR category. Conclusion DOAC use, compared with warfarin use, was associated with lower or similar risk of all-cause death, ischemic stroke and transient ischemic attack and also a lower or similar risk of major bleeding across all levels of kidney function.

Background: Systematic evaluation of patients with the post-COVID-19 infections using standardized symptom assessment tools and laboratory testing in the context of clinical care has not been reported previously. Methods: This is a cohort of individuals referred to post-COVID-19 recovery clinics in British Columbia from July 9, 2020 to March 10, 2022. The purpose of the clinics was to systematically assess patients for 3-month post-COVID-19 infections, using validated symptom assessment tools for shortness of breath, fatigue, neuro-psychiatric symptoms, and organ dysfunction as measured by laboratory tests. Patients were referred according to specified criteria, including hospitalization or persistence of symptoms. For our analysis, we included the patients who were referred and evaluated at 3-month post-COVID-19 infection with persistent symptoms. The period chosen corresponds to waves 1–4 in British Columbia.Results: In total, 892 patients were included (median [IQR] age, 53 [42,63] years, with 54.0% females, 39.7% white ethnicity, and 62.0% hospitalized). Shortness of breath (85.9%), fatigue (75.7%), weakness (56.1%), memory problem (47.3%), and myalgia (45.6%) were the most common symptoms reported. Phenotypes of different patients and wave of infection were found associated with different long COVID-19 clinical manifestations after controlling for vaccination status and the underlying comorbidities. Conclusions: Using validated symptom assessment tools, we describe the variability, severity, and frequency of symptoms in this cohort with long COVID-19. Further studies are required to assess the heterogeneity of the long COVID-19 manifestations using standardized assessments to better target therapeutic treatments. RésuméContexte: L’évaluation systématique des patients après une infection par le SRAS-CoV-2à l’aide d’outils normalisés d’évaluation des symptômes et d’examens de laboratoire dans le contexte des soins cliniques n’a jamais été mise en évidence auparavant. Méthodologie: Il s’agit d’une cohorte de personnes orientées vers des cliniques de rétablissement de la COVID-19 en Colombie-Britannique entre le 9  juillet  2020 et le 10  mars  2022. Ces cliniques visent à évaluer systématiquement les patients trois mois après avoir contracté la COVID-19, à l’aide d’outils d’évaluation des symptômes validés pour l’essoufflement, la fatigue, les symptômes neuropsychiatriques et le dysfonctionnement organique mesurés par des examens de laboratoire.L’orientation des patients vers ces cliniques a été effectuée selon des critères prédéfinis, y compris l’hospitalisation ou la persistance des symptômes. Aux fins de notre analyse, nous avons retenu les patients qui ont été orientés et évalués trois mois après avoir contracté la COVID-19 et qui présentaient des symptômes persistants. La période choisie correspond aux vagues 1 à 4 de COVID-19 en Colombie-Britannique. Résultats: Au total, 892 patients ont fait partie de l’analyse (âge médian de 53 ans,écart interquartile [EIQ] de 42 à 63; 54,0% sont des femmes; 39,7% sont de race blanche; 62,0% ont été hospitalisés). L’essoufflement (85,9%), la fatigue (75,7%), la faiblesse (56,1%), les troubles de la mémoire (47,3%) et la myalgie (45,6%) sont les symptômes mentionnés le plus souvent. On constate que les différents phénotypes des patients et la vague au cours de laquelle est survenue l’infection sont associés à des symptômes différents de la COVID-19 longue après la prise en compte du statut vaccinal et des affections comorbides sous-jacentes. Conclusions: À l’aide d’outils validés d’évaluation des symptômes, nous décrivons la variabilité, la gr-avité et la fréquence des symptômes chez cette cohorte de patients atteints de la COVID-19 longue. D’autres études sont nécessaires pour évaluer l’hétérogénéité des symptômes de la COVID-19 longue au moyen d’évaluations normalisées afin de mieux cibler les traitements curatifs.