Short-term outpatient follow-up of COVID-19 patients: A multidisciplinary approach

de Graaf, M.A.; Antoni, M.L.; ter Kuile, M.M.; Arbous, M.S.; Duinisveld, A.J.F.; Feltkamp, M.C.W.; Groeneveld, G.H.; Hinnen, S.C.H.; Janssen, V.R.; Lijfering, W.M.; Omara, S.; Postmus, P.E.; Ramai, S.R.S.; Rius-Ottenheim, N.; Schalij, M.J.; Schiemanck, S.K.; Smid, L.; Stöger, J.L.; Visser, L.G.; de Vries, J.J.C.; Wijngaarden, M.A.; Geelhoed, J.J.M.; Roukens, A.H.E.

BACKGROUND: Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there are no clear recommendations for follow-up of COVID-19 patients. In this multi-disciplinary evaluation, cardiopulmonary function and psychological impairment after hospitalization for COVID-19 are mapped. METHODS: We evaluated patients at our outpatient clinic 6 weeks after discharge. Cardiopulmonary function was measured by echocardiography, 24-hours ECG monitoring and pulmonary function testing. Psychological adjustment was measured using questionnaires and semi-structured clinical interviews. A comparison was made between patients admitted to the general ward and Intensive care unit (ICU), and between patients with a high versus low functional status. FINDINGS: Eighty-one patients were included of whom 34 (41%) had been admitted to the ICU. New York Heart Association class II-III was present in 62% of the patients. Left ventricular function was normal in 78% of patients. ICU patients had a lower diffusion capacity (mean difference 12,5% P = 0.01), lower forced expiratory volume in one second and forced vital capacity (mean difference 14.9%; P<0.001; 15.4%; P<0.001; respectively). Risk of depression, anxiety and PTSD were 17%, 5% and 10% respectively and similar for both ICU and non-ICU patients. INTERPRETATION: Overall, most patients suffered from functional limitations. Dyspnea on exertion was most frequently reported, possibly related to decreased DLCOc. This could be caused by pulmonary fibrosis, which should be investigated in long-term follow-up. In addition, mechanical ventilation, deconditioning, or pulmonary embolism may play an important role.