Background: Evidence to date indicates that mortality of acute coronavirus disease (COVID-19) is higher in men than in women. Conversely, women seem more likely to suffer from long-term consequences of the disease and pronounced negative social and economic impacts. Sex- and gender-specific risk factors of COVID-19-related long-term effects are unknown.
Methods: We conducted a multicentre prospective observational cohort study of 5838 (44.6% women) individuals in Switzerland who were tested positive for SARS-CoV-2 RNA between February and December 2020. Of all surviving individuals who met the inclusion criteria, 2799 (1285 [45.9%] women) completed a follow-up questionnaire.
Findings: After a mean follow-up time of 197±77 days, women more often reported at least one persistent symptom (43.0% vs 31.5%, p<0.001) with reduced exercise tolerance and reduced resilience being the most frequently reported symptom in both sexes. Critical illness (intermediate or intensive care unit admission) during acute SARS-CoV-2 infection (odds ratio[95%CI]: 4.00[2.66-6.02], p<0.0001 was a risk factor of post-COVID-19 syndrome in both women and men. Women with pre-existing mental illness (1.81[1.00-3.26], p=0.049), cardiovascular risk factors (1.39[1.03-1.89], p=0.033), higher self-reported domestic stress levels (1.15[1.08-1.22], p<0.0001), and feminine gender identity (1.12[1.02-1.24], p=0.02) increased the odds of experiencing post-COVID syndrome. Conversely, obesity (1.44[1.03-2.02], p=0.034) increased the odds of post-COVID-19 syndrome in men, but not in women. Being responsible for household work (men, OR 0.82[0.69-0.97], p=0.021), taking care of children/relatives (women, 0.90[0.84-0.96], p=0.002) or being pregnant at the time of acute COVID-19 illness (OR 0.48[0.23-1.01], p=0.054) was associated with lower odds of post-COVID syndrome.
Interpretation: Predictors of post-COVID syndrome differ between men and women. Our data reinforce the importance to include sex and gender to identify patients at risk for post-COVID syndrome so that access to care and early intervention can be tailored to their different needs.
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): DF. Sager was supported by the Swiss Academy of Medical Sciences and the G.&J. Bangerter-Rhyner Foundation through the “Young Talents in Clinical Research” program.
Background & Purpose
Positron emission tomography (PET)/computed tomography (CT) myocardial perfusion imaging (MPI) is guiding the assessment and management of patients with suspected or known coronary artery disease for over 30 years. Its clinical dissemination and technological evolution might have altered the clinical phenotype of referred patients. The aim of the present study was to investigate temporal trends in patient characteristics, imaging findings of PET/CT MPI and outcome over the course of 15 years.
Methods
In this cross-sectional cohort study, 1366 patients who underwent PET/CT between 2001 and 2015 were retrospectively included. Patients were grouped together into three 5-year study groups (group 1: 2001–2005 / group 2: 2006–2010 / group 3: 2011–2015) and assessed for patient demographics and characteristics, serological biomarkers, relative and quantitative PET findings, and mortality. Vital status was obtained from medical charts and/or death notices.
Results
Across study groups, mean age (p<0.001) and creatinine (p = 0.006) increased while the prevalence of typical angina (p<0.001) and known coronary artery disease (p = 0.003) decreased (Table). There were no temporal changes in neither the prevalence of dyspnea (p = 0.480) and diabetes mellitus (p = 0.146) nor median body mass index (p = 0.064), NT-proBNP (p = 0.532) and troponin (p = 0.385). Although the prevalence of ischemia (p = 0.019) and scar (p = 0.003) decreased over time, median myocardial flow reserve (MFR) worsened (p = 0.001). Over a median follow-up of 5.3 years [interquartile range 3.3–7.4] annualized mortality increased across groups in parallel to the changes in MFR (Figure).
Conclusion
The clinical phenotype of patients referred for PET/CT MPI has changed marginally between 2001 and 2015. The temporal trend towards older, less symptomatic patients with lower prevalence of ischemia and scar but worse MFR and higher mortality highlights the importance of assessing diffuse atherosclerosis and microcirculation beyond focal stenosis to improve risk stratification.
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