COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

Banerjee, Amitava; Li, Kezhi; Pagel, Christina; Abbasizanjani, Hoda; Ahmed, Nida; Ahmed, Badar; Akbari, Ashley; Akinoso-Imran, Abdul Qadr; Allara, Elias; Allery, Freya; Angelantonio, Emanuele Di; Ashworth, Mark; Gupta, Vandana Ayyar; Babu‐Narayan, Sonya V.; Bacon, Seb; Ball, Steve; Banerjee, Ami; Barber, Mark; Barrett, Jessica; Bennie, Marion; Berry, Colin; Beveridge, Jennifer; Birney, Ewan; Bojanić, Lana; Bolton, Thomas; Bone, Anna E; Boyle, Jon P.; Braithwaite, Tasanee; Bray, Ben; Briffa, Norman; Brind, David; Brown, Katherine; Buch, Maya H; Canoy, Dexter; Caputo, Massimo; Carragher, Raymond; Carson, Alan; Cézard, Geneviève; Chang, Jen-Yu Amy; Cheema, Kate; Chin, Richard; Chudasama, Yogini; Cooper, Jennifer; Copland, Emma; Crallan, Rebecca; Cripps, Rachel; Cromwell, David; Ćurčin, Vasa; Curry, Gwenetta; Dale, Caroline; Danesh, John; Das‐Munshi, Jayati; Dashtban, Ashkan; Davies, Alun H.; Davies, Joanna M.; Davies, Gareth; Davies, Neil M; Day, Joshua; Delmestri, Antonella; Denaxas, Spiros; Denholm, Rachel; Dennis, John; Denniston, Alastair K; Deo, Salil V.; Dhillon, Baljean; Docherty, Annemarie B; Dong, T.; Douiri, Abdel; Downs, Johnny; Dregan, Alexandru; Ellins, Elizabeth A; Elwenspoek, Martha M C; Falck, Fabian; Falter, Florian; Fan, Yat Yi; Firth, Joseph; Fraser, Lorna; Friebel, Rocco; Gavrieli, Amir; Gerstung, Moritz; Gilbert, Ruth; Gillies, Clare; Glickman, Myer; Goldacre, Ben; Goldacre, Raph; Greaves, Felix; Green, Mark; Grieco, Luca; Griffiths, Rowena; Gurdasani, Deepti; Halcox, Julian; Hall, Nick; Hama, Tuankasfee; Handy, Alex; Hansell, Anna; Hardelid, Pia; Hardy, F. Joan; Harris, Daniel; Harrison, Camille; Harron, Katie; Hassaïne, Abdelâali; Hassan, Lamiece; Healey, Russell; Hemingway, Harry; Henderson, Angela; Herz, Naomi; Heyl, Johannes; Hidajat, Mira; Higginson, Irene J; Hinchliffe, Rosie; Hippisley‐Cox, Julia; Ho, Frederick K; Hocaoglu, Mevhibe; Hollings, Sam; Horne, Elsie; Hughes, David; Humberstone, Ben; Inouye, Michael; Ip, Samantha; Islam, Nazrul; Jackson, Caroline; Jenkins, David; Jiang, Xiyun; Johnson, Shane D.; Kadam, Umesh; Kallis, Constantinos; Karim, Zainab; Kasan, Jake; Katsoulis, Michalis; Kavanagh, Kimberley; Kee, Frank; Keene, Spencer; Kent, Seamus; Khalid, Sara; Khawaja, Anthony P; Khunti, Kamlesh; Killick, Richard; Kinnear, Deborah J; Knight, Rochelle; Kolamunnage‐Dona, Ruwanthi; Kontopantelis, Evangelos; Kurdi, Amanj; Lacey, Ben; Lai, Alvina G.; Lambarth, Andrew; Larzjan, Milad Nazarzadeh; Lawler, Deborah; Lawrence, Thomas B.; Lawson, Claire; Li, Qiuju; Li, Ken; Llinares, Miguel Bernabeu; Lorgelly, Paula; Lowe, Deborah A.; Lyons, Jane; Lyons, Ronan A; Machado, Pedro; MacLeod, Mary Joan; Macleod, John; Malgapo, Evaleen; Mamas, Mamas A.; Mamouei, Mohammad; Manohar, Sinduja; Mapeta, Rutendo; Martelli, Javiera Léniz; Martos, David Moreno; Mateen, Bilal A.; McCarthy, Aoife; Melville, Craig; Milton, Rebecca; Mizani, Mehrdad A.; Moncusi, Marta Pineda; Moralès, Daniel; Mordi, Ify; Morrice, Lynn; Morris, Carole; Morris, Eva; Mu, Yi; Mueller, Tanja; Murdock, Lars; Nafilyan, Vahé; Nicholson, George; Nikiphorou, Elena; Nolan, John; Norris, Tom; Norris, Ruth; North, Laura; North, Teri-Louise; O’Connell, Dan; Oliver, Dominic; Oluyase, Adejoke; Olvera-Barrios, Abraham; Omigie, Efosa; Onida, Sarah; Padmanabhan, Sandosh; Palmer, Tom; Pasea, Laura; Patel, Riyaz; Payne, Rupert; Pell, Jill P.; Petitjean, Carmen; Pherwani, A.D.; Pickrell, William Owen; Pierotti, Livia; Pirmohamed, Munir; Priedon, Rouven; Prieto-Alhambra, D; Proudfoot, Alastair; Quinn, Terry; Quint, Jennifer; Raffetti, Elena; Rahimi, Kazem; Rao, Shishir; Razieh, Cameron; Roberts, Brian; Rogers, Caroline S.; Rossdale, Jennifer; Salim, Safa; Samani, Nilesh J.; Sattar, Naveed; Schnier, Christian; Schwartz, Roy; Selby, David; Seminog, Olena; Shabnam, Sharmin; Shah, Ajay; Shelton, Jon; Sheppard, James P; Sinha, Shubhra; Skrypak, Mirek; Slapkova, Martina; Sleeman, Katherine E; Smith, Craig J.; Sofat, Reecha; Sosenko, Filip; Sperrin, Matthew; Steeg, Sarah; Sterne, Jonathan A C; Stoica, Șerban; Sudell, Maria; Sudlow, Cathie; Sun, Luanluan; Suseeladevi, Arun Karthikeyan; Sweeting, Michael; Sydes, Matthew R.; Takhar, Rohan; Tang, Howard; Thygesen, Johan Hilge; Tilston, George; Tochel, Claire; Toit, Clea du; Tomlinson, Christopher; Toms, Renin; Torabi, Fatemeh; Torralbo, Ana; Townson, Julia; Tufail, Adnan; Tungamirai, Tapiwa; Varma, Susheel; Vollmer, Sebastian J.; Walker, Venexia; Wang, Tianxiao; Wang, Huan; Warwick, Alasdair; Watkinson, Ruth E.; Watson, Harry C.; Whiteley, William; Whittaker, Hannah; Wilde, Harry; Wilkinson, Tim; Williams, G. V.; Williams, Michelle; Williams, Richard; Withnell, Eloise; Wolfe, Charles D A; Wood, Angela; Wright, Lucy; Wu, Honghan; Wu, Jinge; Wu, Jihuai; Yates, Thomas; Zaccardi, Francesco; Zhang, Haoting; Zhang, Huayu; Zuccolo, Luisa

doi:10.1016/s2589-7500(22)00091-7

Cited by 45 publications

(21 citation statements)

References 23 publications

(18 reference statements)

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“…COVID-19 critical care was defined on the basis of receipt of noninvasive ventilation, invasive mechanical ventilation or extracorporeal membrane oxygenation, or admission to an intensive care unit. 12 Events after hospitalized COVID-19 were classified into those happening during the hospital admission and those happening after discharge. We used the latest available discharge date for the admission.…”

Section: Methodsmentioning

confidence: 99%

Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales

et al. 2022

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Background: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear. Methods: We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history. Results: Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0–22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21–1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3–35.2) in week 1 to 1.80 (95% CI, 1.50–2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses. Conclusions: High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.

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Section: Methodsmentioning

confidence: 99%

Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales

et al. 2022

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“…Appropriate medical and social support is thus required 14 .Previous studies have observed different presentations of PCS, and have proposed PCS should not be regarded as a unique syndrome. Several phenotypes were discerned either empirically [14][15][16] or with automatic methods 17 , in relation to the causes [18][19][20] , phases of the disease 21 , symptom manifestation 11,22 , severity 9,23,24 , outcome 17 , and potential therapies 12 . Semi-supervised and unsupervised methods identified up to eight clusters of symptoms 17,18,22,25,26 ; separating profiles of phenotypic abnormalities with enrichments in pulmonary, cardiovascular, neuropsychiatric, and constitutional symptoms such as fatigue and fever 12,25 .…”

Section: Discussionmentioning

confidence: 99%

Profiling post-COVID syndrome across different variants of SARS-CoV-2

Canas

Molteni

Deng

et al. 2022

Preprint

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Background: Self-reported symptom studies rapidly increased our understanding of SARS-CoV-2 during the pandemic and enabled the monitoring of long-term effects of COVID-19 outside the hospital setting. It is now evident that post-COVID syndrome presents with heterogeneous profiles, which need characterisation to enable personalised care among the most affected survivors. This study describes post-COVID profiles, and how they relate to different viral variants and vaccination status. Methods: In this prospective longitudinal cohort study, we analysed data from 336,652 subjects, with regular health reports through the Covid Symptom Study (CSS) smartphone application. These subjects had reported feeling physically normal for at least 30 days before testing positive for SARS-CoV-2. 9,323 individuals subsequently developed Long-COVID, defined as symptoms lasting longer than 28 days. 1,459 had post-COVID syndrome, defined as more than 12 weeks of symptoms. Clustering analysis of the time-series data was performed to identify distinct symptom profiles for post-COVID patients, across variants of SARS-CoV-2 and vaccination status at the time of infection. Clusters were then characterised based on symptom prevalence, duration, demography, and prior conditions (comorbidities). Using an independent testing sample with additional data (n=140), we investigated the impact of post-COVID symptom clusters on the lives of affected individuals. Findings: We identified distinct profiles of symptoms for post-COVID syndrome within and across variants: four endotypes were identified for infections due to the wild-type variant; seven for the alpha variant; and five for delta. Across all variants, a cardiorespiratory cluster of symptoms was identified. A second cluster related to central neurological, and a third to cases with the most severe and debilitating multi-organ symptoms. Gastrointestinal symptoms clustered in no more than two specific phenotypes per viral variant. The three main clusters were confirmed in an independent testing sample, and their functional impact was assessed. Interpretation: Unsupervised analysis identified different post-COVID profiles, characterised by differing symptom combinations, durations, and functional outcomes. Phenotypes were at least partially concordant with individuals reported experiences. Our classification may be useful to understand distinct mechanisms of the post-COVID syndrome, as well as subgroups of individuals at risk of prolonged debilitation. Funding: UK Government Department of Health and Social Care, Chronic Disease Research Foundation, The Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value-Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation and Alzheimers Society, and ZOE Limited, UK.

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“…As already mentioned, SARS-CoV-2 infection is a new important chapter in medicine that has deeply influenced everyday life and social normalcy in the previous 3 years [24]. Remarkably inflammatory heart disease (such as pericarditis, myocarditis and mixed conditions such as myopericarditis and perimyocarditis) has been associated with adverse prognosis and may be caused either by SARS-CoV-2 infection or vaccination against the virus, especially with mRNA platforms [25].…”

Section: Isolated Acute Pericarditismentioning

confidence: 99%

Incidence and Prevalence of Cardiac Arrhythmias in Pericardial Syndromes

Lazaros¹,

Lazarou²,

Tsioufis³

et al. 2022

Rev. Cardiovasc. Med.

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Arrhythmias in pericardial syndromes have been poorly investigated and available data are mainly obtained from relevant studies however having different endpoints from arrhythmias. Thus, the incidence and prevalence of any type of arrhythmias may be actually higher than generally considered. Atrial arrhythmias, mainly atrial fibrillation and flutter have been reported as the most common rhythm disturbances in the setting of acute pericarditis. Concerning pathophysiology of atrial arrhythmias, in contrast to earlier hypothesis that they occur exclusively in the presence of an underlying structural heart disease, recent data support an arrhythmogenic potential of acute pericardial inflammation regardless of the presence of heart disease. In cases of myopericarditis, namely primarily pericarditis with evidence of myocardial involvement (i.e., troponin elevation without however overt left ventricular dysfunction and/or segmental wall motion abnormalities), ventricular arrhythmias appear to prevail. With reference to the rest of pericardial syndromes data on arrhythmias development are even more sparce. In particular, in constrictive pericarditis atrial tachyarrhythmias are the most commonly detected and seem to be related to disease severity and possibly to the underlying etiology. In this review we have summarized the available information on the incidence and prevalence of arrhythmias in pericardial syndromes. We wish to emphasize that the clinical significance of arrhythmias in this setting in terms of prognosis and optimal medical treatment (including need and safety of anticoagulation in atrial fibrillation/flutter complicating acute pericarditis), should be further investigated.

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COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

Cited by 45 publications

References 23 publications

Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales

Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales

Profiling post-COVID syndrome across different variants of SARS-CoV-2

Incidence and Prevalence of Cardiac Arrhythmias in Pericardial Syndromes

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