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MacEwan SR, Rahurkar S, Tarver WL, Forward C, Eramo JL, Teuschler L, Gaughan AA, Rush LJ, Stanwick S, McConnell E, Schamess A, McAlearney AS. Patient Experiences Navigating Care Coordination For Long COVID: A Qualitative Study. J Gen Intern Med 2024:10.1007/s11606-024-08622-z. [PMID: 38308155 DOI: 10.1007/s11606-024-08622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/09/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Little is known about how to best evaluate, diagnose, and treat long COVID, which presents challenges for patients as they seek care. OBJECTIVE Understand experiences of patients as they navigate care for long COVID. DESIGN Qualitative study involving interviews with patients about topics related to seeking and receiving care for long COVID. PARTICIPANTS Eligible patients were at least 18 years of age, spoke English, self-identified as functioning well prior to COVID infection, and reported long COVID symptoms continued to impact their lives at 3 months or more after a COVID infection. APPROACH Patients were recruited from a post-COVID recovery clinic at an academic medical center from August to September 2022. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. KEY RESULTS Participants (n=21) reported experiences related to elements of care coordination: access to care, evaluation, treatment, and ongoing care concerns. Some patients noted access to care was facilitated by having providers that listened to and validated their symptoms; other patients reported feeling their access to care was hindered by providers who did not believe or understand their symptoms. Patients reported confusion around how to communicate their symptoms when being evaluated for long COVID, and they expressed frustration with receiving test results that were normal or diagnoses that were not directly attributed to long COVID. Patients acknowledged that clinicians are still learning how to treat long COVID, and they voiced appreciation for providers who are willing to try new treatment approaches. Patients expressed ongoing care concerns, including feeling there is nothing more that can be done, and questioned long-term impacts on their aging and life expectancy. CONCLUSIONS Our findings shed light on challenges faced by patients with long COVID as they seek care. Healthcare systems and providers should consider these challenges when developing strategies to improve care coordination for patients with long COVID.
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Affiliation(s)
- Sarah R MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Saurabh Rahurkar
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Willi L Tarver
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, The Ohio State University, Columbus, OH, USA
| | - Cortney Forward
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jennifer L Eramo
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lauren Teuschler
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alice A Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Laura J Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Stacy Stanwick
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Erin McConnell
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Andrew Schamess
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Gyöngyösi M, Hasimbegovic E, Han E, Zlabinger K, Spannbauer A, Riesenhuber M, Hamzaraj K, Bergler-Klein J, Hengstenberg C, Kammerlander A, Kastl S, Loewe C, Beitzke D. Improvement of Symptoms and Cardiac Magnetic Resonance Abnormalities in Patients with Post-Acute Sequelae of SARS-CoV-2 Cardiovascular Syndrome (PASC-CVS) after Guideline-Oriented Therapy. Biomedicines 2023; 11:3312. [PMID: 38137533 PMCID: PMC10742066 DOI: 10.3390/biomedicines11123312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiac magnetic resonance (CMR) studies reported CMR abnormalities in patients with mild-moderate SARS-CoV-2 infection, suggesting ongoing myocardial inflammation. Patients (n = 278, 43 ± 13 years, 70.5% female) with post-acute sequelae of SARS-CoV-2 cardiovascular syndrome (PASC-CVS) were included prospectively into the Vienna POSTCOV Registry between March 2021 and March 2023 (clinicaltrials.gov NCT05398952). Clinical, laboratory, and CMR findings were recorded. Patients with abnormal CMR results were classified into isolated chronic pericardial (with/without pleural) effusion, isolated cardiac function impairment, or both (myopericarditis) groups. Medical treatment included a nonsteroidal anti-inflammatory agent (NSAID) for pericardial effusion and a condition-adapted maximal dose of heart failure (HF) treatment. Three months after medical therapy, clinical assessment and CMR were repeated in 82 patients. Laboratory analyses revealed normal hematological, inflammatory, coagulation, and cardiac biomarkers. CMR abnormalities were found in 155 patients (55.8%). Condition-adapted HF treatment led to a significant increase in the left ventricular ejection fraction (LVEF) in patients with initially reduced LVEF (from 49 ± 5% to 56 ± 4%, p = 0.009, n = 25). Low-moderate doses of NSAIDs for 3 months significantly reduced pericardial effusion (from 4/3;5.75/mm to 2/0;3/mm, median/interquartile ranges/p < 0.001, n = 51). Clinical symptoms improved markedly with a decrease in CMR abnormalities, which might be attributed to the maintenance of NSAID and HF medical treatment for PASC-CVS.
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Affiliation(s)
- Mariann Gyöngyösi
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Ena Hasimbegovic
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Emilie Han
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Katrin Zlabinger
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Andreas Spannbauer
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Martin Riesenhuber
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Kevin Hamzaraj
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Jutta Bergler-Klein
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Christian Hengstenberg
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Andreas Kammerlander
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Stefan Kastl
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (C.L.); (D.B.)
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (C.L.); (D.B.)
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Gyöngyösi M, Lukovic D, Mester-Tonczar J, Zlabinger K, Einzinger P, Spannbauer A, Schweiger V, Schefberger K, Samaha E, Bergler-Klein J, Riesenhuber M, Nitsche C, Hengstenberg C, Mucher P, Haslacher H, Breuer M, Strassl R, Puchhammer-Stöckl E, Loewe C, Beitzke D, Hasimbegovic E, Zelniker TA. Effect of monovalent COVID-19 vaccines on viral interference between SARS-CoV-2 and several DNA viruses in patients with long-COVID syndrome. NPJ Vaccines 2023; 8:145. [PMID: 37773184 PMCID: PMC10541897 DOI: 10.1038/s41541-023-00739-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023] Open
Abstract
Epstein-Barr virus (EBV) reactivation may be involved in long-COVID symptoms, but reactivation of other viruses as a factor has received less attention. Here we evaluated the reactivation of parvovirus-B19 and several members of the Herpesviridae family (DNA viruses) in patients with long-COVID syndrome. We hypothesized that monovalent COVID-19 vaccines inhibit viral interference between SARS-CoV-2 and several DNA viruses in patients with long-COVID syndrome, thereby reducing clinical symptoms. Clinical and laboratory data for 252 consecutive patients with PCR-verified past SARS-CoV-2 infection and long-COVID syndrome (155 vaccinated and 97 non-vaccinated) were recorded during April 2021-May 2022 (median 243 days post-COVID-19 infection). DNA virus-related IgG and IgM titers were compared between vaccinated and non-vaccinated long-COVID patients and with age- and sex-matched non-infected, unvaccinated (pan-negative for spike-antibody) controls. Vaccination with monovalent COVID-19 vaccines was associated with significantly less frequent fatigue and multiorgan symptoms (p < 0.001), significantly less cumulative DNA virus-related IgM positivity, significantly lower levels of plasma IgG subfractions 2 and 4, and significantly lower quantitative cytomegalovirus IgG and IgM and EBV IgM titers. These results indicate that anti-SARS-CoV-2 vaccination may interrupt viral cross-talk in patients with long-COVID syndrome (ClinicalTrials.gov Identifier: NCT05398952).
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Affiliation(s)
- Mariann Gyöngyösi
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
| | - Dominika Lukovic
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Julia Mester-Tonczar
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Katrin Zlabinger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Patrick Einzinger
- Institute of Information Systems Engineering, Research Unit of Information and Software Engineering, Vienna University of Technology, 1040, Vienna, Austria
| | - Andreas Spannbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Victor Schweiger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Katharina Schefberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Eslam Samaha
- Department of Internal Medicine I, Klinik Donaustadt, Vienna, Austria
| | - Jutta Bergler-Klein
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Martin Riesenhuber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Patrick Mucher
- Biobank, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Biobank, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Monika Breuer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ena Hasimbegovic
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas A Zelniker
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Garrett RE, Palacio CH, Bar-Or D. Long COVID: Is there a kidney link? Front Med (Lausanne) 2023; 10:1138644. [PMID: 37077670 PMCID: PMC10106649 DOI: 10.3389/fmed.2023.1138644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
Metabolic causes such as altered bioenergetics and amino acid metabolism may play a major role in Long COVID. Renal-metabolic regulation is an integral part of these pathways but has not been systematically or routinely investigated in Long COVID. Here we discuss the biochemistry of renal tubular injury as it may contribute to Long COVID symptoms. We propose three potential mechanisms that could be involved in Long COVID namely creatine phosphate metabolism, un-reclaimed glomerular filtrate and COVID specific proximal tubule cells (PTC) injury-a tryptophan paradigm. This approach is intended to allow for improved diagnostics and therapy for the long-haul sufferers.
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Affiliation(s)
- Raymond E. Garrett
- Swedish Medical Center, Trauma Research Dept., Englewood, CO, United States
| | - Carlos H. Palacio
- South Texas Health System, Trauma Research Dept., McAllen, TX, United States
| | - David Bar-Or
- Swedish Medical Center, Trauma Research Dept., Englewood, CO, United States
- South Texas Health System, Trauma Research Dept., McAllen, TX, United States
- *Correspondence: David Bar-Or,
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