GP consultation rates for sequelae after acute covid-19 in patients managed in the community or hospital in the UK: population based study

Abstract

ObjectivesTo describe the rates for consulting a general practitioner (GP) for sequelae after acute covid-19 in patients admitted to hospital with covid-19 and those managed in the community, and to determine how the rates change over time for patients in the community and after vaccination for covid-19.DesignPopulation based study.Setting1392 general practices in England contributing to the Clinical Practice Research Datalink Aurum database.Participants456 002 patients with a diagnosis of covid-19 between 1 August 2020 and 14 February 2021 (44.7% men; median age 61 years), admitted to hospital within two weeks of diagnosis or managed in the community, and followed-up for a maximum of 9.2 months. A negative control group included individuals without covid-19 (n=38 511) and patients with influenza before the pandemic (n=21 803).Main outcome measuresComparison of rates for consulting a GP for new symptoms, diseases, prescriptions, and healthcare use in individuals admitted to hospital and those managed in the community, separately, before and after covid-19 infection, using Cox regression and negative binomial regression for healthcare use. The analysis was repeated for the negative control and influenza cohorts. In individuals in the community, outcomes were also described over time after a diagnosis of covid-19, and compared before and after vaccination for individuals who were symptomatic after covid-19 infection, using negative binomial regression.ResultsRelative to the negative control and influenza cohorts, patients in the community (n=437 943) had significantly higher GP consultation rates for multiple sequelae, and the most common were loss of smell or taste, or both (adjusted hazard ratio 5.28, 95% confidence interval 3.89 to 7.17, P<0.001); venous thromboembolism (3.35, 2.87 to 3.91, P<0.001); lung fibrosis (2.41, 1.37 to 4.25, P=0.002), and muscle pain (1.89, 1.63 to 2.20, P<0.001); and also for healthcare use after a diagnosis of covid-19 compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients in the community were joint pain (2.5%), anxiety (1.2%), and prescriptions for non-steroidal anti-inflammatory drugs (1.2%). Patients admitted to hospital (n=18 059) also had significantly higher GP consultation rates for multiple sequelae, most commonly for venous thromboembolism (16.21, 11.28 to 23.31, P<0.001), nausea (4.64, 2.24 to 9.21, P<0.001), prescriptions for paracetamol (3.68, 2.86 to 4.74, P<0.001), renal failure (3.42, 2.67 to 4.38, P<0.001), and healthcare use after a covid-19 diagnosis compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients admitted to hospital were venous thromboembolism (3.5%), joint pain (2.7%), and breathlessness (2.8%). In patients in the community, anxiety and depression, abdominal pain, diarrhoea, general pain, nausea, chest tightness, and tinnitus persisted throughout follow-up. GP consultation rates were reduced for all symptoms, prescriptions, and healthcare use, except for neuropathic pain, cognitive impairment, strong opiates, and paracetamol use in patients in the community after the first vaccination dose for covid-19 relative to before vaccination. GP consultation rates were also reduced for ischaemic heart disease, asthma, and gastro-oesophageal disease.ConclusionsGP consultation rates for sequelae after acute covid-19 infection differed between patients with covid-19 who were admitted to hospital and those managed in the community. For individuals in the community, rates of some sequelae decreased over time but those for others, such as anxiety and depression, persisted. Rates of some outcomes decreased after vaccination in this group.

Health care use attributable to COVID-19: A propensity matched national electronic health records cohort study of 249,390 people in Wales, UK

“…The finding that those who survive COVID show higher rates of cardiovascular disease is in agreement with other published findings, such as findings that several cardiovascular disorders are higher in veterans data in the US (17) and higher rates of venous thromboembolism (6) using CPRD data in the UK. However, the finding that there is no overall increase in diagnosis of mental health problems was at odds with literature from the US veterans study(16) and a study using the US TriNetX (3) dataset which both find higher rates of psychiatric morbidity and mental health diagnosis after COVID (18).…”

“…However, age, self-reported health status before the onset of symptoms, self-reported pre-existing comorbidities and the number of symptoms during the infection were found to significantly predict the number of symptoms patients with long COVID may experience at follow-up (5). The most common symptoms presented to the GP, four weeks after infection, were joint pain (2.5%), anxiety (1.2%) and prescription of non-steroidal anti-inflammatory drugs (1.2%) using routine medical record data (6).…”

“…The large numbers of SARS-CoV-2 infections could lead to a further demand on healthcare because of long COVID. At present, there is limited data (6) available to inform health systems about the scale of demand that might be expected and what services might be sought. However, establishing the extent to which these conditions are attributable to COVID-19 or reflect disease burden among the general population can be difficult.…”

A clinical review of long-COVID with a focus on the respiratory system

“…In a meta-analysis, breathlessness was estimated to affect 32% (95% CI 18–47; 16 studies, n = 4,283) of individuals with long-COVID [8]. The experience of breathlessness is likely to be more common in those who required hospitalisation for COVID-19 [10], for instance, in the PHOSP-COVID cohort, 51% of individuals reported breathlessness 12 months following discharge [11]. Estimates for the prevalence of other respiratory symptoms following COVID-19 also vary depending on if patients required hospitalisation and the duration of follow-up.…”

“…In contrast, in the PHOSP-COVID cohort, which had a higher proportion of individuals with more severe acute disease than the Chinese study, only 29% of individuals felt fully recovered 12 months since discharge [11]. Current evidence suggests that breathlessness, cough (though not chest pain) are reported less frequently as time since acute COVID- 19 extends [10,12 ▪ ]. The proportion of individuals with abnormalities on lung function testing or chest imaging may also reduce over time, though further studies which include individuals in the community are required to verify these observations [14 ▪ ].…”