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TOPLINE: 

Despite improvements in outcomes at 3 years after hospitalisation for COVID-19, health problems remained prevalent, with self-reported fatigue and cognitive issues worsening significantly between years 2 and 3 post-discharge. Additionally, post-exertional malaise (PEM) affected nearly one third of patients at 3 years after discharge.

METHODOLOGY: 

• Researchers conducted a prospective cohort study across seven hospitals and three rehabilitation centres in the Netherlands to assess the prevalence of PEM in patients hospitalised for COVID-19.
• Overall, 650 patients hospitalised for COVID-19 between July 2020 and October 2021 were enrolled in the initial 2-year study. Herein, 299 patients continued and completed the final 3-year extension study.
• The analysis included patient-reported outcome measures such as recovery, fatigue, sleep quality, and anxiety, assessed using standardised scales at 3, 6, 12, 24, and 36 months post-discharge with a particular focus on changes between years 2 and 3.
• The prevalence of PEM was assessed at 3 years post-discharge, and its associated risk factors were identified in patients with and without it.

TAKEAWAY:

• The prevalence of symptoms of impaired fitness, fatigue, and muscle weakness decreased significantly during the overall follow-up period (P < .0019 for all).
• Moreover, the prevalence of memory problems increased significantly between years 2 and 3 (odds ratio [OR], 1.4; P < .001), with the scores of fatigue (P = .002), cognitive failures (P < .001), and 36-Item Short Form Health Survey (SF-36; P < .001) significantly worsened.
• At 3 years, PEM was reported by 36% of patients, with female sex (OR, 3.4; P < .001), preexisting pulmonary disease (OR, 3.0; P < .001), pre–COVID-19 physical inactivity (OR, 2.3; P = .008), and ICU treatment for COVID-19 (OR, 1.8; P = .04) identified as risk factors for PEM after hospitalisation for COVID-19.
• Patients with PEM showed consistently worse health outcomes throughout the 3-year follow-up, with significant worsening in fatigue scores and SF-36 scores between years 2 and 3.

IN PRACTICE:

"Our findings highlight the urgent need for research into effective management strategies for long COVID, as well as the importance of ongoing monitoring of disease trajectory to better understand the long-term outcomes of COVID-19," the authors wrote.

SOURCE: 

This study was led by Julia C. Berentschot, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. It was published online on April 06, 2025, in The Lancet Regional Health - Europe.

LIMITATIONS: 

This study lacked control groups of individuals without COVID-19 and those not hospitalised for COVID-19. The findings may not generalise to patients who were not hospitalised or those vaccinated before admission. Finally, this study relied heavily on patient-reported outcome measures, which could have introduced bias in estimating health problems.

DISCLOSURES: 

This work was funded by the COVID-19 Program Care and Prevention of The Netherlands Organisation for Health Research and Development, Rijndam Rehabilitation, and Laurens. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.