A Year After Acute Infection, Adults With Long COVID Had Increased Adverse Outcomes

We are now 3 years into the COVID-19 pandemic, and yet myriad unknowns remain. One of the most mysterious aspects of COVID-19 is why some patients experience post-acute sequelae of COVID-19, often called “post-COVID-19 conditions” or “long COVID.”

The US Centers for Disease Control and Prevention (CDC) defines long COVID as new, returning, or ongoing health issues that occur more than 4 weeks after an initial COVID-19 infection. Additionally, approximately 1 in 8 COVID-19 patients experience symptoms at least 3 months after acute illness. The most common post-COVID-19 conditions include fatigue, cough, pain in the joints, throat, or chest, loss of taste or smell, shortness of breath, thromboembolic conditions, neurocognitive difficulties, and depression.

The severity of these symptoms can range from inconvenient to debilitating, but can post-acute sequelae of COVID-19 increase the risk of adverse outcomes as long as a year after infection? A new original investigation, published in JAMA Health Forum, sought to answer this question of long-term outcomes for individuals with post-COVID-19 conditions.

This case-control study quantified 1-year outcomes among individuals with long COVID. Adults diagnosed with long COVID were propensity score-matched to adults with no evidence of contracting COVID-19 during the study period of April 1, 2020-July 31, 2021.

Investigators leveraged a large commercial insurance database to recruit the study patients, members of commercial health plans. The investigators used national insurance claims data enhanced with laboratory results, as well as mortality data from the Social Security Administration’s Death Master File and Datavant Flatiron data.

The primary adverse outcomes measured were cardiovascular and respiratory events, as well as general mortality, assessed over a 12-month period in individuals with long COVID.

The study population was comprised of 13435 individuals with post-COVID-19 conditions and 26870 individuals with no evidence of COVID-19. The combined cohort was 58.4% female, and the average age was 51 years. During the follow-up period, the long COVID patients required an increased utilization of health care services, including cardiac arrhythmias, pulmonary embolism, ischemic stroke, coronary artery disease, heart failure, chronic obstructive pulmonary disease, and asthma.

Additionally, the long COVID patients had a mortality rate of 2.8%, compared to the controls’ 1.2% mortality rate. This equates to an excess death rate of 16.4 per 1000 individuals with long COVID.

This study conclusively found elevated rates of adverse outcomes over a 1-year period in a cohort of long COVID patients who survived the acute phase of illness. The study authors recommended continued monitoring of at-rick individuals with post-COVID-19 conditions, especially regarding potential cardiovascular and pulmonary concerns.