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Large numbers of people are being discharged from hospital following COVID-19 without assessment of recovery. In 384 patients (mean age 59.9 years; 62% male) followed a median 54 days post discharge, 53% reported persistent breathlessness, 34% cough and 69% fatigue. 14.6% had depression. In those discharged with elevated biomarkers, 30.1% and 9.5% had persistently elevated d-dimer and C reactive protein, respectively. 38% of chest radiographs remained abnormal with 9% deteriorating. Systematic follow-up after hospitalisation with COVID-19 identifies the trajectory of physical and psychological symptom burden, recovery of blood biomarkers and imaging which could be used to inform the need for rehabilitation and/or further investigation.

IntroductionPost-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients.MethodsIn a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression.Results1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6–52.8) years vs 58.3 (47.0–67.7) years and 48.5 (39.4–55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118–298) days, 69 (51–111) days and 76 (55–128) days; all p<0.0001). All groups had similar rates of onward specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were more likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). Hospitalised patients had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 716 (54.0%) individuals reported <75% optimal health (median 70%, IQR 55%–85%). Less than half of employed individuals could return to work full time at first assessment.ConclusionPost-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.

ObjectiveTo characterise long-term trajectory of recovery in individuals with long covid.DesignProspective cohort.SettingSingle-centre, specialist post-COVID service (London, UK).ParticipantsIndividuals aged ≥18 years with long covid (hospitalised and non-hospitalised) from April 2020 to March 2024.Main outcome measuresRoutine, prospectively collected data on symptoms, quality of life (including Fatigue Assessment Scale (FAS) and EuroQol 5 Dimensions (EQ-5D), return to work status and healthcare utilisation (investigations, outpatient and emergency attendances). The primary outcome was recovery by self-reported >75% of ‘best health’ (EQ-5D Visual Analogue Scale) and was assessed using Cox proportional hazards regression models over 4 years. Linked National Health Service England registry data provided secondary care healthcare utilisation and expenditure.ResultsWe included 3590 individuals (63.3% female, 73.5% non-hospitalised, median age 50.0 years, 71.9% with ≥2 doses of COVID-19 vaccination), who were followed up for a median of 136 (0–346) days since first assessment and 502 (251–825) days since symptom onset. At first assessment, 33.2% of employed individuals were unable to work. Dominant symptoms were fatigue (78.7%), breathlessness (68.1%) and brain fog (53.5%). 33.4% of individuals recovered to >75% of best health prior to clinic discharge (recovery occurred median 202 (94–468) days from symptom onset). Vaccinated individuals were more likely to recover faster (pre: HR 2.93 (2.00–4.28) and post: HR 1.34 (1.05–1.71) COVID-19 infection), whereas recovery hazard was inversely associated with FAS (HR 0.37 (0.33–0.42)), myalgia (HR 0.59 (0.45–0.76)) and dysautonomic symptoms (HR 0.46 (0.34–0.62)). There was high secondary care healthcare utilisation (both emergency and outpatient care). Annual inpatient and outpatient expenditure was significantly lower in hospitalised individuals while under the service. When compared with the prereferral period, emergency department attendances were reduced in non-hospitalised patients with long covid, but outpatient costs increased.ConclusionsIn the largest long covid cohort from a single specialist post-COVID service to date, only one-third of individuals under follow-up achieved satisfactory recovery. Fatigue severity and COVID-19 vaccination at presentation, even after initial COVID-19 infection, was associated with long covid recovery. Ongoing service provision for this and other post-viral conditions is necessary to support care, progress treatment options and provide capacity for future pandemic preparedness. Research and clinical services should emphasise these factors as the strongest predictors of non-recovery.

The pathogenesis of exercise intolerance and persistent fatigue which can follow an infection with the SARS‐CoV‐2 virus (“long COVID”) is not fully understood. Cases were recruited from a long COVID clinic (N = 32; 44 ± 12 years; 10 (31%) men), and age‐/sex‐matched healthy controls (HC) (N = 19; 40 ± 13 years; 6 (32%) men) from University College London staff and students. We assessed exercise performance, lung and cardiac function, vascular health, skeletal muscle oxidative capacity, and autonomic nervous system (ANS) function. Key outcome measures for each physiological system were compared between groups using potential outcome means (95% confidence intervals) adjusted for potential confounders. Long COVID participant outcomes were compared to normative values. When compared to HC, cases exhibited reduced oxygen uptake efficiency slope (1847 (1679, 2016) vs. 2176 (1978, 2373) mL/min, p = 0.002) and anaerobic threshold (13.2 (12.2, 14.3) vs. 15.6 (14.4, 17.2) mL/kg/min, p < 0.001), and lower oxidative capacity, measured using near infrared spectroscopy (τ: 38.7 (31.9, 45.6) vs. 24.6 (19.1, 30.1) s, p = 0.001). In cases, ANS measures fell below normal limits in 39%. Long COVID is associated with reduced measures of exercise performance and skeletal muscle oxidative capacity in the absence of evidence of microvascular dysfunction, suggesting mitochondrial pathology. There was evidence of attendant ANS dysregulation in a significant proportion. These multisystem factors might contribute to impaired exercise tolerance in long COVID sufferers.

IntroductionThe COVID-19 pandemic has led to over 100 million cases worldwide. The UK has had over 4 million cases, 400 000 hospital admissions and 100 000 deaths. Many patients with COVID-19 suffer long-term symptoms, predominantly breathlessness and fatigue whether hospitalised or not. Early data suggest potentially severe long-term consequence of COVID-19 is development of long COVID-19-related interstitial lung disease (LC-ILD).Methods and analysisThe UK Interstitial Lung Disease Consortium (UKILD) will undertake longitudinal observational studies of patients with suspected ILD following COVID-19. The primary objective is to determine ILD prevalence at 12 months following infection and whether clinically severe infection correlates with severity of ILD. Secondary objectives will determine the clinical, genetic, epigenetic and biochemical factors that determine the trajectory of recovery or progression of ILD. Data will be obtained through linkage to the Post-Hospitalisation COVID platform study and community studies. Additional substudies will conduct deep phenotyping. The Xenon MRI investigation of Alveolar dysfunction Substudy will conduct longitudinal xenon alveolar gas transfer and proton perfusion MRI. The POST COVID-19 interstitial lung DiseasE substudy will conduct clinically indicated bronchoalveolar lavage with matched whole blood sampling. Assessments include exploratory single cell RNA and lung microbiomics analysis, gene expression and epigenetic assessment.Ethics and disseminationAll contributing studies have been granted appropriate ethical approvals. Results from this study will be disseminated through peer-reviewed journals.ConclusionThis study will ensure the extent and consequences of LC-ILD are established and enable strategies to mitigate progression of LC-ILD.

Existing projects leveraging social media in medical education include online journal clubs where authors defend their work during a global meeting of minds and 'tweet chats' that flatten the hierarchy and allow the wider multidisciplinary team (including patients) to contribute to learning about a subject area in a public forum. 10 11 None of this would be recognised by William Osler. [...]as social creatures, working in the socially situated science of medicine, we must resist simply codifying and classifying social media according to current ideas about how we practice medicine or medical education.

IntroductionPost-COVID syndrome (PCS) is a well-recognised and frequently debilitating constellation of signs and symptoms that persist for at least 12 weeks after COVID-19 infection. Cardiovascular symptoms, particularly those associated with inappropriate sinus tachycardia (IST), are common and can include palpitations and breathlessness, which impede patients in their daily tasks and can be difficult to manage. Previous research has suggested that dysautonomia, a dysfunction in the autonomic nervous system, might underlie most PCS symptoms. However, its role in the development of IST within the context of PCS has not been fully investigated. This retrospective study aims to examine the prevalence of IST and cardiovascular symptoms in PCS patients who undergo 24-hour Holter monitoring. In addition, we aim to analyse the demographic characteristics of individuals affected by these symptoms and assess cardiovascular autonomic function by analysing heart rate variability (HRV), to investigate the role of dysautonomia in the development of IST in PCS.MethodsWe undertook a retrospective cohort analysis of symptomatic PCS patients referred to our multidisciplinary PCS Clinic at UCLH between March 2020 and February 2023. We identified 685 eligible patients who underwent diagnostic 24-hour ECG monitoring. Excluding patients on therapies or with conditions that could affect heart rate, we conducted a comparative sub-analysis on 524 patients, dividing them into two groups of IST (mean 24-hour HR≥90bpm, n=100) and non-IST (mean 24-hour HR<90bpm, n=424). The heart rate data extracted from the 24-hour ECG records of these patients were ported into the KUBIOS HRV standard software for HRV analysis and assessment of sympathetic and parasympathetic activity based on time and frequency domain analysis, which could indicate cardiovascular dysautonomia. Demographic data were analysed using basic descriptive statistics and a chi-square test between the two groups using GraphPad Prism software.ResultsThe frequency domain component of the HRV analysis revealed that the LF/HF ratio was significantly higher in the IST group (2.78 ± 1.89) compared to the non-IST group (2.15 ± 1.93, p<0.001). The sympathetic nervous system (SNS) index was significantly higher in the IST group (1.50 ± 0.77 versus -0.13 ±0.70, p<0.001), whilst the parasympathetic nervous system (PNS) index was significantly lower in the IST group (-1.75 ± 0.65 versus -0.16 ± 1.61, p<0.001).ConclusionsIn PCS patients with IST, dysautonomia leads to an imbalance in the sympathovagal regulation of the heart, with decreased parasympathetic activity and increased sympathetic activity, with parasympathetic down-regulation being more pronounced. Addressing dysautonomia and promoting parasympathetic activity could thereby improve PCS management strategies to restore a balanced autonomic regulation of the cardiovascular system.Abstract 97 Table 1The baseline characteristics of two post-COVID-19 populations: the inappropriate sinus tachycardia (IST) group and the non-IST group. Age and body mass index (BMI) data are presented as mean ± standard deviation (SD) IST group n=100 Non-IST group n=424 P value Demographic and clinical characteristics Age, years ± SD 41.39 ± 10.55 43.37 ± 11.09 0.105 Females, n (%) 81 (81) 306 (72.17) 0.071 BMI, mean kg/m2 ± SD 29.79 ± 6.36 27.11 ± 6.07 <0.001 Healthy weight (BMI 18.5- 24.9), n (%) 22 (27.16) 116 (40) 0.035 Overweight (BMI 25- 29.9), n (%) 25 (30.86) 100 (34.48) 0.542 Obese (BMI 30+), n (%) 34 (41.98) 74 (25.52) 0.004 Smoking, n (%) 17 (17) 42 (9.91) 0.186 Type II diabetes (clinically diagnosed), n (%) 13 (13) 12 (2.86) <0.001 Abstract 97 Table 2Compares the prevalence of post-COVID-19 symptoms in two populations: the inappropriate sinus tachycardia (IST) group and the non-IST group IST group n=100 Non-IST group n=424 P value PCS manifestations Palpitations, n (%) 74 (74) 249 (58.73) 0.012 Breathlessness, n (%) 84 (84) 301 (70.99) 0.008 Disturbed sleep, n (%) 78 (78) 257 (60.61) 0.004 POTS 38 (38) 48 (11.32) <0.001 Exercise intolerance, n (%) 70 (70) 235 (55.42) 0.019 Headache, n (%) 67 (67) 212 (50) 0.004 Fever, n (%) 37 (37) 38 (8.96) <0.001 Muscle and joint pain, n (%) 74 (74) 198 (46.70) <0.001 Abstract 97 Figure 1The LF/HF ratio represents the overall symapthovagal balance. P-values of p<0.001 are shown as ***. The error bars represent the standard deviationAbstract 97 Figure 2SNS and PNS indexes. P-values of p<0.001 are shown as ***. The error bars represent the standard deviationConflict of InterestNone