Medium-Term Outcomes in COVID-19

COVID-19 causes severe illness that results in morbidity and mortality. Electrocardiographic features, including QT prolongation, have been associated with poor acute outcomes; data on the medium-term outcomes remain scarce. This study evaluated the 1-year outcomes of patients who survived the acute COVID-19 infection. Methods and Materials: Data of the 159 patients who survived the COVID-19 illness during the first wave (1 March 2020-18 May 2020) were collected. Patient demographics, laboratory findings and electrocardiography data were evaluated. Patients who subsequently died within 1-year of the index illness were compared to those who remained well. Results: Of the 159 patients who had survived the index illness, 28 (17.6%) subsequently perished within 1-year. In comparison to the patients that were alive after 1-year, the deceased were older (68 vs. 83 years, p < 0.01) and equally male (60.4% vs. 53.6%, p = 0.68), with a similar proportion of hypertension (59.5% vs. 57.1%, p = 0.68), diabetes (25.2% vs. 39.2%, p = 0.096) and ischaemic heart disease (11.5% vs. 7.1%, p = 0.54). The QTc interval for the alive and deceased patients shortened by a similar degree from the illness to post-COVID (-26 +/- 33.5 vs. -20.6 +/- 30.04 milliseconds, p = 0.5); the post-COVID R-R interval was longer in the alive patients compared to the deceased (818.9 +/- 169.3 vs. 761.1 +/- 61.2 ms, p = 0.02). A multivariate Cox regression analysis revealed that age (HR1.098 [1.045-1.153], p < 0.01), diabetes (HR3.972 [1.47-10.8], p < 0.01) and the post-COVID R-R interval (HR0.993 [0.989-0.996], p < 0.01) were associated with 1-year mortality. Conclusions: The COVID-19-associated mortality risk extends to the post-COVID period. The QTc does recover following the acute illness and is not associated with outcomes; the R-R interval is a predictor of 1-year mortality.

Automated summary

COVID-19 infection is associated with mortality within 1 year, and electrocardiographic features, including age, diabetes, and post-COVID R-R interval, are predictors of mortality.