Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort study

McAuley, Hamish; Abel, Kathryn M.; Adamali, Huzaifa; Adeloye, Davies; Adeyemi, Oluwafikayo S; Adrego, R.; Jiménez, Laura; Ahmad, Shazaad; Haider, Nafees; Ahmed, Rizwan; Ahwireng, N.; Ainsworth, Mark; Al-Sheklly, Bashar; Alamoudi, A.; Ali, Muhammad; Aljaroof, M; All, A.M.; Allan, Louise; Allen, R J; Allerton, L.; Allsop, Lynne; Almeida, P.; Altmann, Doris; Corral, Maria Alvarez; Amoils, S.; Anderson, Debra; Antoniades, C; Arbane, Gill; Arias, Ana; Armour, Chérie; Armstrong, Lará; Armstrong, Natalie; Arnold, David; Arnold, Horace D.; Ashish, Abdul; Ashworth, Andrew; Ashworth, Mark; Aslani, Shahab; Assefa-Kebede, H.; Atkin, Catherine; Atkin, Philip A.; Aul, Raminder; Aung, Htin; Austin, Luke; Avram, Cristina; Ayoub, A.; Babores, Marta; Baggott, Rob; Bagshaw, J.; Baguley, David; Bailey, L. Charles; Baillie, J Kenneth; Bain, SC; Bakali, M; Bakau, M; Baldry, Eileen; Baldwin, Danielle; Baldwin, Molly; Clive, Ballard; Banerjee, Amitava; Bang, B.; Barker, Ruth E; Barman, L.; Barratt, Shaney; Barrett, Fiona; Basire, D.; Basu, Neil; Bates, Michelle; Bates, Andrew; Batterham, Rachel L.; Baxendale, Helen; Bayes, Hannah; Beadsworth, Michael; Beckett, P.; Beggs, M.; Begum, Masrath; Beirne, Paul; Bell, Derek; Bell, Robert M.; Bennett, Katherine A.; Beranova, Eva; Bermperi, Areti; Berridge, A.; Berry, Colin; Betts, Sarah; Bevan, Emily; Bhui, Kam; Bingham, M.; Birchall, Kathrine; Bishop, Lisa; Bisnauthsing, Karen; Blaikely, J; Bloss, Angela; Bolger, Aidan P.; Bolton, Charlotte E.; Bonnington, J; Botkai, A; Bourne, C.; Bourne, Michelle; Bramham, Kate; Brear, Lucy; Breen, Gerome; Breeze, Janis L.; Briggs, Andrew; Bright, Eddie A; Brightling, Christopher; Brill, Simon; Brindle, K; Broad, Lauren; Broadley, Andrew; Brookes, C.; Broome, Marion E.; Brown, Ammani; Brown, Jeremy; Brown, Michael J.; Brown, Victoria Tzortziou; Brugha, Traolach; Brunskill, Nigel; Buch, Maya H; Buckley, Philip; Bularga, Anda; Bullmore, Edward T.; Burden, L.; Burdett, Teresa; Burn, D; Burns, Graham; Burns, Angus C; Busby, John; Butcher, R.; Butt, Adeel A.; Byrne, Suzanne; Cairns, Paula; Calder, P.C.; Calvelo, E.; Carborn, H.; Card, Brittany; Carr, Christine; Carr, Loretta; Carson, Gail; Carter, P.; Casey, A; Cassar, Mark Philip; Cavanagh, Jorunn Pauline; Chablani, Manish; Chalder, Trudie; Chalmers, James D.; Chambers, Robert; Chan, Francis K.L.; Channon, K.M.; Chapman, Katie; Charalambou, Amanda; Chaudhuri, Nazia; Checkley, Anna M.; Chen, J.; Cheng, Yu; Chetham, L.; Childs, C.; Chilvers, Edwin R.; Chinoy, Hector; Chiribiri, A.; Chong-James, K; Choudhury, Gourab; Choudhury, Noura J.; Chowienczyk, P.; Christie, C. D. C.; Chrystal, M.; Clark, Diane; Clark, Collin M.; Clarke, Jennifer; Clohisey, Sara; Coakley, G.; Coburn, Z.; Coetzee, Samantha; Cole, Jacob; Coleman, Christopher M.; Conneh, F.; Connell, D; Connolly, Bronwen; Connor, L.; Cook, Amanda; Cooper, Brendan; Cooper, Jackie A.; Cooper, Sheldon C.; Copeland, D.; Cosier, Tracey; Coulding, Martina; Coupland, Cherry; Cox, Ellie; Craig, Tom; Crisp, Philippe; Cristiano, Daniele; Crooks, Michael G.; Cross, Andy; Cruz, Igor; Cullinan, Paul; Cuthbertson, Daniel J; Daines, Luke; Dalton, M.; Daly, Patricia; Daniels, A.; Dark, Paul; Dasgin, Joanne; David, Abel P.; David, Clara; Davies, Elin Haf; Davies, Ffyon; Davies, Gwyn; Davies, Kim; Davies, Matthew J.; Dawson, Jennifer; Daynes, Enya; Soyza, Anthony De; Deakin, B; Deans, Andrew R.; Deas, Catherine; Deery, Joanne; Defres, Sylviane; Dell, Amanda; Dempsey, Katherine; Denneny, Emma; Dennis, John; Dewar, Amy; Dharmagunawardena, R; Diar-Bakerly, N.; Dickens, Chris; Dipper, Alexandra; Diver, Sarah; Diwanji, S.N.; Dixon, Michael J.; Djukanović, Ratko; Dobson, Hannah; Dobson, Susan L; Docherty, Annemarie B; Donaldson, A; Dong, T.; Dormand, Natalie; Dougherty, Andrew; Dowling, Rowan; Drain, S; Draxlbauer, K.; Drury, Kay; drury, H.J.C.; Dulawan, P.; Dunleavy, A.; Dunn, S.; Dupont, C.; Earley, J.; Easom, Nicholas; Echevarria, Carlos; Edwards, Sarah; Edwardson, Charlotte L.; El-Taweel, Hosni; Elliott, Angela; Elliott, Katharine; Ellis, Yvette; Elmer, Anne; Elneima, Omer; Evans, D; Evans, Helen; Evans, Joanne; Evans, Rachael A.; Evans, R.; Evans, Teriann; Evenden, C.; Evison, Lynsey; Fabbri, L.; Fairbairn, Sara; Fairman, Andrea D.; Fallon, K; Faluyi, David; Favager, C; Fayzan, T.; Featherstone, Jonathan; Felton, Timothy; Finch, Joanne; Finney, Simon J.; Finnigan, J.; Finnigan, L.; Fisher, Helen; Fletcher, Simon; Flockton, R.; Flynn, Maura; Foot, H.; Foote, Dru; Ford, Amber; Forton, Daniel; Fraile, Eva; Francis, Charlotte; Francis, Rebecca; Francis, Sarah L.; Frankel, Adam; Fraser, Emily; Free, Robert C; French, Nigel P.; Fu, Xiaotong; Fuld, Jonathan; Furniss, James J; Garner, Linda; Gautam, Nandan; Geddes, John; George, Jenny S.; George, Peter M.; Gibbons, Michael; Gill, Mandy; Gilmour, Lesley; Gleeson, Fergus; Glossop, Jodie; Glover, Sarah C.; Goodman, Nigel; Goodwin, C W; Gooptu, Bibek; Gordon, Howard S.; Gorsuch, T; Greatorex, M.; Greenhaff, Paul L.; Greenhalf, William; Greenhalgh, Alan; Greening, Neil; Greenwood, J; Gregory, H.; Gregory, R.; Grieve, Douglas; Griffin, Denise; Griffiths, Lori; Guerdette, A.-M.; Guio, B. 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doi:10.1016/j.eclinm.2023.101896

Cited by 9 publications

(4 citation statements)

References 33 publications

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“… 17–19 As the recovery profiles presented in our study are related to pre-COVID-19 cardiovascular status, we posit that it is deconditioning following the hospital admission which limits the rate of recovery, as has been noted in different frailty phenotypes. 20 Sarcopenic measures in our study, such as the incremental shuttle walk distance, were 18%–31% lower in cardiovascular groups compared with the reference group after adjustment for age, sex and ethnicity: this equates to an average walking speed of less than 1 m/s. By comparison, the walking distances achieved at 1 year in the cardiovascular groups are comparable with age and sex-matched reference distances for patients who are routinely referred to outpatient cardiac rehabilitation programmes, namely 66% of the distance achieved by a healthy population.…”

Section: Discussionmentioning

confidence: 47%

Long COVID and cardiovascular disease: a prospective cohort study

Lawson,

Moss,

Arnold

et al. 2024

Open Heart

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BackgroundPre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known.ObjectivesTo determine whether the rate of patient-perceived recovery following hospitalisation with COVID-19 was affected by the presence of CVD or cardiovascular risk factors.MethodsIn a multicentre prospective cohort study, patients were recruited following discharge from the hospital with COVID-19 undertaking two comprehensive assessments at 5 months and 12 months. Patients were stratified by the presence of either CVD or cardiovascular risk factors prior to hospitalisation with COVID-19 and compared with controls with neither. Full recovery was determined by the response to a patient-perceived evaluation of full recovery from COVID-19 in the context of physical, physiological and cognitive determinants of health.ResultsFrom a total population of 2545 patients (38.8% women), 472 (18.5%) and 1355 (53.2%) had CVD or cardiovascular risk factors, respectively. Compared with controls (n=718), patients with CVD and cardiovascular risk factors were older and more likely to have had severe COVID-19. Full recovery was significantly lower at 12 months in patients with CVD (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.89) and cardiovascular risk factors (aOR 0.66, 95% CI 0.50 to 0.86).ConclusionPatients with CVD or cardiovascular risk factors had a delayed recovery at 12 months following hospitalisation with COVID-19. Targeted interventions to reduce the impact of COVID-19 in patients with cardiovascular disease remain an unmet need.Trail registration numberISRCTN10980107.

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Section: Discussionmentioning

confidence: 47%

Long COVID and cardiovascular disease: a prospective cohort study

Lawson,

Moss,

Arnold

et al. 2024

Open Heart

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“…A recent study by McAuley et al. ( 2023 ) identified physical inactivity as a driver for limited recovery and frailty in individuals 1 year after hospital discharge from COVID‐19, which we can integrate into a plausible mechanism. This has important implications, as encouraging physical activity in such individuals may be appropriate to improve metabolic health.…”

Section: Discussionmentioning

confidence: 62%

DYNamic Assessment of Multi‐Organ level dysfunction in patients recovering from COVID‐19: DYNAMO COVID‐19

Gupta,

Nicholas,

McGing

et al. 2024

Experimental Physiology

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We evaluated the impacts of COVID‐19 on multi‐organ and metabolic function in patients following severe hospitalised infection compared to controls. Patients (n = 21) without previous diabetes, cardiovascular or cerebrovascular disease were recruited 5–7 months post‐discharge alongside controls (n = 10) with similar age, sex and body mass. Perceived fatigue was estimated (Fatigue Severity Scale) and the following were conducted: oral glucose tolerance (OGTT) alongside whole‐body fuel oxidation, validated magnetic resonance imaging and spectroscopy during resting and supine controlled exercise, dual‐energy X‐ray absorptiometry, short physical performance battery (SPPB), intra‐muscular electromyography, quadriceps strength and fatigability, and daily step‐count. There was a greater insulin response (incremental area under the curve, median (inter‐quartile range)) during the OGTT in patients [18,289 (12,497–27,448) mIU/min/L] versus controls [8655 (7948–11,040) mIU/min/L], P < 0.001. Blood glucose response and fasting and post‐prandial fuel oxidation rates were not different. This greater insulin resistance was not explained by differences in systemic inflammation or whole‐body/regional adiposity, but step‐count (P = 0.07) and SPPB scores (P = 0.004) were lower in patients. Liver volume was 28% greater in patients than controls, and fat fraction adjusted liver T1, a measure of inflammation, was raised in patients. Patients displayed greater perceived fatigue scores, though leg muscle volume, strength, force‐loss, motor unit properties and post‐exercise muscle phosphocreatine resynthesis were comparable. Further, cardiac and cerebral architecture and function (at rest and on exercise) were not different. In this cross‐sectional study, individuals without known previous morbidity who survived severe COVID‐19 exhibited greater insulin resistance, pointing to a need for physical function intervention in recovery.

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“…Frailty and pre-frailty were present in more than two-thirds of participants at 1 year. 20 A fall in the number of participants working at 1 year was seen, with 8.5% of those who were working before hospitalization no longer working and 34.6% of participants reporting that COVID-19 had resulted in a change in their occupation ( Supplementary Table S7 , available as Supplementary data at IJE online). Results from the complete Tier 2 cohort for the early and 1-year research visits are included in Tables 3 and 4 .…”

Section: What Has It Found?mentioning

confidence: 99%

“… 21 Frailty was also positively associated with non-recovery and reduced health-related quality of life at 1 year following discharge. 20 …”

Section: What Has It Found?mentioning

confidence: 99%

Cohort Profile: Post-Hospitalisation COVID-19 (PHOSP-COVID) study

Elneima,

McAuley,

Leavy

et al. 2023

International Journal of Epidemiology

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Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort study

Cited by 9 publications

References 33 publications

Long COVID and cardiovascular disease: a prospective cohort study

Long COVID and cardiovascular disease: a prospective cohort study

DYNamic Assessment of Multi‐Organ level dysfunction in patients recovering from COVID‐19: DYNAMO COVID‐19

Cohort Profile: Post-Hospitalisation COVID-19 (PHOSP-COVID) study

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