Symptom burden, coagulopathy and heart disease, and quality of life at baseline and after 1-year follow-up following acute SARS-CoV-2 infection in a community medicine setting
Authors: Colleran R , Rai H , Fitzgerald S , Mcgovern L , Byrne R J , Cradock A , Lavery R , Bisset J , Mckeogh S , Cantwell G , O'ciardha D , Mcnulty J , Szeplaki G , O'donnell J P , Byrne R A 
Published: November 2023

Abstract

Introduction
Several studies assessing the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/COVID-19 on myocardial tissue through the medium of cardiac magnetic resonance (CMR) imaging have been published. These studies have generally been small or have focused on specific populations. The prevalence and severity of heart disease and coagulopathy in a community setting following recovery from severe COVID-19 infection are not well characterised.

Purpose
The aim of SETANTA (Study of HEarT DiseAse and ImmuNiTy After COVID-19 in Ireland) study was to investigate symptom burden and incidence of cardiac abnormalities after recovery from COVID-19 infection and correlate these results with immunological response, biomarkers of coagulation and quality of life.

Methods
The SETANTA study was a prospective, single-arm, cross-sectional study conducted in a community medicine setting. Patients with recent COVID-19 infection ≥ 6 weeks and ≤ 12 months before enrolment were enrolled. Primary outcomes of interest and inclusion/exclusion criteria are summarised in Figure 1.

Results
100 patients were included in the study, 64% were female. Mean age was 45.2 years. The median (interquartile range) time interval between COVID-19 infection and enrolment was 189 [125, 246] days. 83% had at least one persistent symptom. 96% had positive serology for prior SARS-CoV-2 infection. CMR results are summarised in Figure 1. Late gadolinium enhancement and pericardial effusion was present in 2.2% and 8.3% respectively; left ventricular ejection fraction was below the normal reference limit in 17.4% of patients. Von Willebrand factor antigen was elevated in 32.7% of patients. Fibrinogen and D-Dimer levels were raised in 10.2% and 11.1% of patients, respectively.
In total 99, 100 and 97 patients completed their 1, 6 and 12-month telephone follow-ups respectively. There were no significant serious adverse events reported at 6-months follow-up; one case of hospitalization for 7 nights for fever of unknown origin was reported at 12 months. All 100 patients completed their modified version of SAQ7 (Seattle Angina Questionnaire, short form) and EQ-5D-5L (EuroQol 5-dimension 5 level) questionnaires at baseline, while 75 and 72 patients, respectively, completed both their questionnaires at 6- and 12-month follow-up timepoints; responses are displayed as Figure 2 (SAQ7 as Panel A, and EQ-5D-5L as Panel B) and show improvement over time in terms of symptoms as well as quality of life though the follow-up period.

Conclusions
In a cohort of primary practice patients recently recovered from SARS-CoV-2 infection, prevalence of persistent symptoms and markers of abnormal coagulation were high, despite a lower frequency of abnormalities on cardiac MRI compared with prior reports of patients assessed in a hospital setting. Symptom burden improved over time and there were no major adverse events during follow-up to 1 year.Figure 1.Figure 2.