Short-term outpatient follow-up of COVID-19 patients: A multidisciplinary approach

Abstract

Background: Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there are no clear recommendations for follow-up of COVID-19 patients. In this multi-disciplinary evaluation, cardiopulmonary function and psychological impairment after hospitalization for COVID-19 are mapped. Methods: We evaluated patients at our outpatient clinic 6 weeks after discharge. Cardiopulmonary function was measured by echocardiography, 24-hours ECG monitoring and pulmonary function testing. Psychological adjustment was measured using questionnaires and semi-structured clinical interviews. A comparison was made between patients admitted to the general ward and Intensive care unit (ICU), and between patients with a high versus low functional status. Findings: Eighty-one patients were included of whom 34 (41%) had been admitted to the ICU. New York Heart Association class II-III was present in 62% of the patients. Left ventricular function was normal in 78% of patients. ICU patients had a lower diffusion capacity (mean difference 12,5% P = 0.01), lower forced expiratory volume in one second and forced vital capacity (mean difference 14.9%; P<0.001; 15.4%; P<0.001; respectively). Risk of depression, anxiety and PTSD were 17%, 5% and 10% respectively and similar for both ICU and non-ICU patients. Interpretation: Overall, most patients suffered from functional limitations. Dyspnea on exertion was most frequently reported, possibly related to decreased DLCOc. This could be caused by pulmonary fibrosis, which should be investigated in long-term follow-up. In addition, mechanical ventilation, deconditioning, or pulmonary embolism may play an important role.

A systematic review of neuropsychological and psychiatric sequalae of COVID-19: implications for treatment

“…Memory complaints were reported in 19.5–34.0% of participants and attention difficulties were reported in 24.4–28.0% of participants [ 18 , 19 ]. de Graaf [ 20 ] reported cognitive complaints in 25.0% of participants. Medical comorbidities were associated with more frequent report of concentration difficulties and memory loss [ 19 ].…”

“…In 19 of 33 studies assessing depression [ 2 , 11 ▪ , 12 ▪ , 13 ▪▪ , 14 ▪▪ , 16 , 17 , 20 , 24 , 28 , 29 ▪ , 30 , 31 – 34 ], symptom rates ranged from 10.0 to 68.5%. Previously hospitalized patients experienced high rates of depression both in the near- and long-term following hospital discharge.…”

“…One study found that, among adults in quarantine facilities in China, the prevalence rate of acute stress symptoms was 31.0% [ 25 ]. PTS prevalence among patients not held in a quarantine facility ranged from 7.0 to 36.4% [ 17 , 20 , 24 , 28 , 29 ▪ , 30 , 33 – 35 , 41 ]. On average, 10.0–28.0% survivors endorsed symptoms consistent with acute stress reaction [ 28 , 29 ▪ , 30 , 35 ].…”

“…Among studies that evaluated Post Traumatic Stress Disorder (PTSD), prevalence rates of 10.0% were reported 6 weeks postdischarge [ 20 ], whereas others reported rates of 36.4% 2 months posthospitalization [ 24 ]. Three to four months posthospitalization, 25.6% of survivors endorsed symptoms consistent with mild PTSD, 11.3% endorsed moderate symptoms, and 5.9% endorsed severe symptoms [ 41 ].…”

La incógnita del coronavirus – Variantes y vacunas - La gestante y su niño

“…La disnea de esfuerzo fue la más frecuente, posiblemente relacionada con fibrosis pulmonar. Además, la ventilación mecánica, el desacondicionamiento o la embolia pulmonar puedan haber tenido un papel importante (19) .…”