Assessment of Symptom, Disability, and Financial Trajectories in Patients Hospitalized for COVID-19 at 6 Months
Authors: Admon Andrew J. , Iwashyna Theodore J. , Kamphuis Lee A. , Gundel Stephanie J. , Sahetya Sarina K. , Peltan Ithan D. , Chang Steven Y. , Han Jin H. , Vranas Kelly C. , Mayer Kirby P. , Hope Aluko A. , Jolley Sarah E. , Caldwell Ellen , Monahan Max L. , Hauschildt Katrina , Brown Samuel M. , Aggarwal Neil R. , Thompson B. Taylor , Hough Catherine L. ,   National Heart, Lung, and Blood Institute PETAL Network, Abi Fadel Francois , Aboodi Michael , Acquah Samuel , Adams Jason Y , Aggarwal Neil , Alappan Narendrakumar , Albertson Timothy E , Al-Jaghbeer Mohammed , Almasri Eyad , Andrews James S , Angus Derek C , Baker Jason V , Baron Rebecca , Baumann Michael , Becker Torben , Biehl Michelle , Bixby Billie A , Bledsoe Joseph R , Bloom John W , Bose Somnath , Boyle Katherine L , Bradley Patrick , Branson Rich D , Brown Samuel , Burnham Ellen L , Calfee Carolyn , Callahan Sean J , Cancelliere Alessandro , Carson Shannon , Casey Jonathan D , Chang Steven Y , Chekuri Sweta , Chen Peter , Chen Tina , Chenoweth James , Choi Philip , Co Ivan , Collins Sean , Costa Monteiro Ana Carolina , Couper Mick , Cox Christopher , Daich Jonathan , de Wit Marjolein , deBoisblanc Ben P , Dettmer Matthew R , Dhar Sanjay , Dillon David , Doernberg Sarah , Doshi Pratik B , Douglas Ivor S , Driver Brian , Dugar Siddharth P , Duggal Abhijit , Elie Marie-Carmelle , Enfield Kyle B , Eppensteiner John , Fein Daniel , Filbin Michael , Files Clark , Finigan James H , Flannery Alexander H , Foulkes Andrea , Fowler Alpha A , Frisch Adam , Fung Monica , Gaillard John , Galbraith James W , Gandotra Sheetal , Gardner-Gray Jayna M , Gay Elizabeth A , Gibbs Kevin , Gill Evanpaul , Ginde Adit , Girard Timothy D , Go Pauline H , Goel Neha N , Goligher Ewan C , Gomez-Arroyo Jose , Gong Michelle Ng , Goodwin Andrew J , Gordon Richard D , Grissom Colin K , Gunnerson Kyle , Han Jin Ho , Hanane Tarik , Hansen Christopher K , Happel Kyle , Harris Estelle S , Haukoos Jason , Hendey Gregory W , Hendrickson Carolyn M , Hibbert Kathryn A , Hirshberg Ellie , Hite R. Duncan , Hope Aluko A , Hoth Jason , Hou Peter C , Hough Terri , Howrylak Judie A , Huang David T , Hudock Kristin , Huebinger Ryan , Hurst Gina , Hypes Cameron D , Hyzy Robert C , Iovine Nicole , Islam Marjan , Israel Jennifer , Iwashyna Jack , Jaffer Faraz , Janssen William , Jayaprakash Namita , Jia Shijing , Johnson Nicholas J , Jolley Sarah , Jones Alan , Jones Elizabeth Jones B , Kadl Alex , Kangelaris Kirsten N , Kashiouris Markos G , Kass Lawrence E , Keller Marla , Khan Akram , Khosravi Mehdi , Khouli Hassan , Kinni Harish , Kiyatkin Michael E , Knox Daniel , Krishnan Amita , Kurtzman Nicholas , Lammi Matthew R , Lanspa Michael J , Le Viet , Leither Lindsay M , Levitt Joseph , L'Heureux Michael , Lim George , Limkakeng Alexander , Lin Michael Y , Lindsell Christopher , Liu Kathleen , Lyn-Kew Kenneth , Lyons Patrick G , Mackay Fraser C , Maher Patrick J , Mahler Simon A , Malhotra Anita , Malley Brian E , Matthay Michael A , May Teresa , Mayer Katherine , Mayer Kirby P , McSparron Jakob I , McVerry Bryan J , Miller Chadwick D , Miller Stephen , Minear Steven C , Mireles Eduardo , Mock Jason , Mohamed Amira , Montgomery-Yates Ashley A , Morris Peter , Mosier Jarrod M , Moskowitz Ari , Moss Marc , Mucha Simon R , Munroe Elizabeth , Nair Rahul , Nandi Utsav , Nassisi Denise , Nkemdirim William , Norton Dustin L , O'Gara Brian , O'Hearn Daniel J , OMahony Darragh Shane , Page David B , Paine Robert , Park Pauline K , Pasha Sara , Patarroyo Aponte Gabriel D , Patel Avignat , Patel Bela , Peltan Ithan D , Perman Sarah , Pflaum-Carlson Jacqueline Marie , Phang-Lyn Simone , Pinto-Plata Victor , Prekker Matthew E , Puskarich Mike , Qadir Nida , Reddy Raju M , Rice Todd W , Richardson Lynne D , Riker Richard R , Rivers Emanuel P , Robinson Bryce RH , Rogers Angela J , Russell Derek W , Sahoo Debasis , Sandrock Christian , Sanne Shane , Scheraga Rachel G , Schmidt Eric , Schooler Jordan B , Schwab Kristin , Self Wesley H , Semler Matthew W , Sergot Paulina , Shah Faraaz , Shapiro Nate , Shaw Daniel L , Sherwin Robert , Siuba Matthew , Sjoding Michael , Smithline Howard , Sochor Mark R , Spurzem John R , Srinivasan Vasisht , Steel Tessa L , Steingrub Jay S , Stenson Bryan , Sterling Sarah A , Stopyra Jason , Stubblefield William-May B , Sturek Jeffrey M , Sturgill Jamie L , Swiderek Jennifer , Syed Aamer , Talmor Daniel , Tatem Geneva , Thiruchelvam Nirosshan , Thompson Taylor , Thompson Bastin Melissa L , Tidswell Mark , Torbati Sam S , Trent Stacy A , Trott Terren , Van der Kloot Thomas E , Vranas Kelly C , Wang Bonnie , Wang Ralph , Ware Lorraine , Waters Christopher M , Weissman Alexandra J , Wick Katherine D , Wilkin Aimee M , Wilson David M , Wilson Jenny G , Wyles David L , Yanta Joseph H , Yealy Donald M , Youngquist Scott , Zaman Tanzira 
Published: February 2023

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 &amp;lt; .001). Decreases were noted over the same interval for prevalent financial problems (from 66.1% to 56.4%; P &amp;lt; .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.