Multidisciplinary Center Care for Long COVID Syndrome–A Retrospective Cohort Study - 12/07/23
, Bianca Lavelle, MD b, Janet Miller, BS a, Millenia Jimenez, BS c, Patrick H. Lim, MS c, Zachary S. Orban, BS c, Jeffrey R. Clark, BA c, Ria Tomar, BS a, Amy Ludwig, MD a, Sareen T. Ali, BS c, Grace K. Lank, BS c, Allison Zielinski, MD d, Ruben Mylvaganam, MD a, Ravi Kalhan, MD a, Malek El Muayed, MD e, R. Kannan Mutharasan, MD d, Eric M. Liotta, MD, MS c, Jacob I Sznajder, MD a, Charles Davidson, MD d, Igor J. Koralnik, MD c, 1, Marc A. Sala, MD a, 1for the
Northwestern Medicine Comprehensive COVID Center Investigators
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Abstract |
Background |
Persistent multi-organ symptoms after coronavirus disease 2019 (COVID-19) have been termed “long COVID” or “post-acute sequelae of SARS-CoV-2 infection.” The complexity of these clinical manifestations posed challenges early in the pandemic as different ambulatory models formed out of necessity to manage the influx of patients. Little is known about the characteristics and outcomes of patients seeking care at multidisciplinary post-COVID centers.
Methods |
We performed a retrospective cohort study of patients evaluated at our multidisciplinary comprehensive COVID-19 center in Chicago, Ill, between May 2020 and February 2022. We analyzed specialty clinic utilization and clinical test results according to severity of acute COVID-19.
Results |
We evaluated 1802 patients a median of 8 months from acute COVID-19 onset, including 350 post-hospitalization and 1452 non-hospitalized patients. Patients were seen in 2361 initial visits in 12 specialty clinics, with 1151 (48.8%) in neurology, 591 (25%) in pulmonology, and 284 (12%) in cardiology. Among the patients tested, 742/916 (81%) reported decreased quality of life, 284/553 (51%) had cognitive impairment, 195/434 (44.9%) had alteration of lung function, 249/299 (83.3%) had abnormal computed tomography chest scans, and 14/116 (12.1%) had elevated heart rate on rhythm monitoring. Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19. Non-hospitalized patients with positive SARS-CoV-2 testing had findings similar to those with negative or no test results.
Conclusions |
The experience at our multidisciplinary comprehensive COVID-19 center shows common utilization of multiple specialists by long COVID patients, who harbor frequent neurologic, pulmonary, and cardiologic abnormalities. Differences in post-hospitalization and non-hospitalized groups suggest distinct pathogenic mechanisms of long COVID in these populations.
Le texte complet de cet article est disponible en PDF.Résumé |
• | Multidisciplinary centers efficiently provide access to specialty care for the broad range of organ systems involved in long COVID. |
• | Neurology, pulmonary, and cardiology are the most commonly utilized specialties in an established multidisciplinary center. |
• | When long COVID patients receive appropriate specialty care, abnormal diagnostic test results are common, even among patients not hospitalized for acute infection. |
Keywords : Health service delivery, Long COVID, Multidisciplinary care, PASC, Post-acute sequelae of SARS-CoV-2 infection
Plan
| Funding: This work was supported, in part, by a generous gift from Mr and Mrs Michael Ferro. Dr. Joseph Bailey's work on this project was supported, in part, by the National Institutes of Health/the National Heart, Lung, and Blood Institute (grant 5T32HL076139) and the National Institutes of Health/the National Heart, Lung, and Blood Institute (grant UL1TR001422). |
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| Conflict of Interest: None. |
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| Declaration of Competing Interest: The authors declare no competing interests. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
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