Assessment of Symptom, Disability, and Financial Trajectories in Patients Hospitalized for COVID-19 at 6 Months

Abstract

ImportanceIndividuals who survived COVID-19 often report persistent symptoms, disabilities, and financial consequences. However, national longitudinal estimates of symptom burden remain limited.ObjectiveTo measure the incidence and changes over time in symptoms, disability, and financial status after COVID-19–related hospitalization.Design, Setting, and ParticipantsA 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.ExposureHospitalization for COVID-19 as identified with a positive SARS-CoV-2 molecular test.Main Outcomes and MeasuresNew 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.ResultsA 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 < .001). Decreases were noted over the same interval for prevalent financial problems (from 66.1% to 56.4%; P < .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 RelevanceThe 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.

Patient adverse financial outcomes before and after COVID‐19 infection

“…In a recent national survey of COVID-19 survivors who had been hospitalized, half reported that their hospitalization had been a strain on their finances and 23% reported having used all or most of their savings. 2,3 Research examining patients' out-of-pocket costs for COVID-19 hospitalization and postdischarge care have also found that some patients experience a significant burden of out-of-pocket spending for their care. [4][5][6] However, objective measurements of patients' financial outcomes after COVID-19 infection and hospitalization have not yet been examined, particularly studies that can distinguish the impacts of individuals' COVID-19 infection from broader economic disruptions during the pandemic.…”

Association of Severe COVID-19 and Persistent COVID-19 Symptoms With Economic Hardship Among US Families

“…Symptoms of PCCs can adversely affect daily functioning and have been associated with a lower likelihood of working full time and a higher likelihood of being unemployed . COVID-19–associated hospitalizations have been similarly associated with job loss . In addition to the direct associations with patients’ work and earnings, household finances may be further stressed by out-of-pocket medical expenses and lost caretaker productivity .…”

“…COVID-19–associated hospitalizations have been similarly associated with job loss . In addition to the direct associations with patients’ work and earnings, household finances may be further stressed by out-of-pocket medical expenses and lost caretaker productivity . The consequences may be even more severe for families with low income who have fewer resources available to buffer against COVID-19–related financial shocks but appear to be more likely to experience severe or long-term health effects from COVID-19 …”