Long COVID Syndrome, Mortality and Morbidity in Patients Hospitalized with COVID-19 From 16 Countries: The World Heart Federation Global COVID-19 Study.

IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Global Heart Pub Date : 2025-08-01 eCollection Date: 2025-01-01 DOI:10.5334/gh.1452
Karen Sliwa, Kavita Singh, Kalyani Nikhare, Dimple Kondal, Lana Raspail, Meetushi Jain, Shahin Akter, Shamim Hayder Talukder, Toru Kato, Silvia Bertagnolio, Jamie Rylance, Amitava Banerjee, Jagat Narula, Daniel Pineiro, Pablo Perel, Dorairaj Prabhakaran
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引用次数: 0

Abstract

Background: Long-term adverse consequences of the COVID-19 infection affect many organ systems, which requires comprehensive understanding of the disease burden and determinants of persistent long COVID-19 symptoms in diverse population. However, data on long COVID complications are sparse, particularly from low- and middle-income countries (LMICs). The World Heart Federation (WHF) global study assessed the incidence of vascular complications, persistent long COVID symptoms and factors associated with mortality and major adverse cardiovascular events (MACE) among patients with COVID-19 up to one year after hospitalization.

Methods: We recruited a total of 2535 patients hospitalized with COVID-19 and followed up to one-year post-hospital discharge. We collected data on long COVID symptoms, quality of life, and clinical outcomes, including new onset diseases, MACE, and mortality at 1-, 3-, 6-, and 9-12 months post-discharge. Descriptive and generalized estimating equation (GEE) regression analysis was performed to assess the factors associated with mortality and MACE.

Findings: The majority of participants were recruited from LMICs (64%) and male (56%) with a mean (SD) age of 59.5 (20.0) years. Among those tested for COVID-19 strain (52%), Omicron strain was the most prevalent (98%). The follow-up rate at one year was 90%. Over half of the participants (56%) reported experiencing at least one major long COVID symptom (fatigue, breathlessness, anxiety, chest pain, and palpitations) at 1-month, and one-quarter participants reported persistent long COVID symptoms at 9-12 months. On the EQ-5D scale, 49% reported difficulties in usual activities, 33% reported anxiety/depression, and 23% reported problems in mobility within the first 6 months. The most frequent new-onset illnesses were pulmonary embolism (8%), kidney disease (4%), and hypertension (3%). The cumulative all-cause mortality rate was 15% (n = 382) at one-year post-discharge. Long COVID symptoms were more common among females, individuals with pre-existing comorbidities, and those with more severe acute illness. Age, obesity, ICU admission, and underlying cardiovascular or pulmonary disease were associated with increased risk of mortality and MACE.

Conclusion: The study showed a substantial burden of mortality and morbidity, and a quarter of patients reported at least one persistent long COVID symptom after one year. Our findings underscore the need for early identification and management of long COVID symptoms in LMICs.

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16个国家COVID-19住院患者的长冠状病毒综合征、死亡率和发病率:世界心脏联合会全球COVID-19研究
背景:COVID-19感染的长期不良后果影响许多器官系统,这需要全面了解不同人群中持续长期COVID-19症状的疾病负担和决定因素。然而,关于长期COVID并发症的数据很少,特别是来自低收入和中等收入国家的数据。世界心脏联合会(WHF)的全球研究评估了2019冠状病毒病(COVID-19)患者在住院后长达一年的血管并发症、持续的长期COVID-19症状以及与死亡率和主要不良心血管事件(MACE)相关的因素的发生率。方法:共招募新冠肺炎住院患者2535例,随访至出院后1年。我们收集了出院后1、3、6和9-12个月的长期COVID症状、生活质量和临床结果的数据,包括新发疾病、MACE和死亡率。采用描述性和广义估计方程(GEE)回归分析评估与死亡率和MACE相关的因素。研究结果:大多数参与者来自中低收入国家(64%)和男性(56%),平均(SD)年龄为59.5(20.0)岁。在COVID-19菌株检测中(52%),Omicron菌株最为普遍(98%)。一年随访率为90%。超过一半的参与者(56%)报告在1个月时至少出现一种主要的长期COVID症状(疲劳、呼吸困难、焦虑、胸痛和心悸),四分之一的参与者报告在9-12个月时持续出现长期COVID症状。在EQ-5D量表中,49%的人在前6个月内报告了日常活动困难,33%的人报告了焦虑/抑郁,23%的人报告了行动不便。最常见的新发疾病是肺栓塞(8%)、肾脏疾病(4%)和高血压(3%)。出院后1年的累积全因死亡率为15% (n = 382)。长时间的COVID症状在女性、已有合并症的个体和患有更严重急性疾病的个体中更为常见。年龄、肥胖、ICU住院和潜在的心血管或肺部疾病与死亡率和MACE风险增加相关。结论:该研究显示了大量的死亡率和发病率负担,四分之一的患者在一年后至少报告了一次持续的长时间COVID症状。我们的研究结果强调了在中低收入国家早期识别和管理长期COVID症状的必要性。
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来源期刊
Global Heart
Global Heart Medicine-Cardiology and Cardiovascular Medicine
CiteScore
5.70
自引率
5.40%
发文量
77
审稿时长
5 weeks
期刊介绍: Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.
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