![]() In addition to symptom persistence and clinical sequelae that may last far beyond the initial COVID-19 illness, the extent of emotional and behavioral concerns and general distress for those affected has yet to be determined. However, an increased incidence of heart failure as a major sequela of COVID-19 is of concern, with considerable potential implications for the general population of older adults with multimorbidity, as well as for younger previously healthy patients, including athletes. 6 The durability and consequences of such imaging findings are not yet known and longer follow-up is needed. Nevertheless, among 26 competitive college athletes who received a diagnosis of COVID-19 by reverse transcriptase–polymerase chain reaction, none of whom required hospitalization and the majority without reported symptoms, 12 (46%) had evidence of myocarditis or prior myocardial injury by cardiac magnetic resonance imaging routinely performed for positive testing results (range, 12-53 days later). However, the sample was not random and likely biased toward patients with cardiac findings. 5 The presence of chronic comorbidities, duration and severity of acute COVID-19 illness, and time since original diagnosis did not correlate with these findings. In a German study of 100 patients who recently recovered from COVID-19, cardiac magnetic resonance imaging (performed a median of 71 days after COVID-19 diagnosis) revealed cardiac involvement in 78% and ongoing myocardial inflammation in 60%. Myocardial inflammation and myocarditis, as well as cardiac arrhythmias, have been described after SARS-CoV-2 infection. Myocardial injury, as defined by an increased troponin level, has been described in patients with severe acute COVID-19, along with thromboembolic disease. Notwithstanding, 1 in 5 individuals aged 18-34 years without chronic medical conditions had not yet achieved baseline health when interviewed at a median of 16 days from the testing date. 4 Older than 50 years and the presence of 3 or more chronic medical conditions were associated with not returning to usual health within 14 to 21 days after receiving a positive test result. In a telephone survey conducted by the Centers for Disease Control and Prevention among a random sample of 292 adults (≥18 years) who had a positive outpatient test result for SARS-CoV-2 by reverse transcriptase–polymerase chain reaction, 35% of 274 symptomatic respondents reported not having returned to their usual state of health 2 weeks or more after testing, including 26% among those aged 18-34 years (n = 85), 32% among those aged 35-49 years (n = 96), and 47% among those aged 50 years or older (n = 89). However, postacute COVID-19 syndrome is not just observed among patients who had severe illness and were hospitalized. 2 In a study from Italy that assessed COVID-19 symptom persistence among 143 patients discharged from the hospital, only 18 patients (12.6%) were completely free of any COVID-19–related symptoms after a mean of 60 days after initial symptom onset. In a 2016 study among 43 patients who had been discharged after intensive care unit stay (46% required mechanical ventilation), 36 (84%) reported impairment in cognition, mental health, or physical function that persisted for 6 to 12 months beyond hospital discharge, collectively known as post–intensive care syndrome. Previously described, a postacute syndrome is well recognized in patients who are recovering from a serious illness, in particular an illness that required hospitalization and admission to the intensive care unit. 1 It is possible that individuals with symptoms were more likely to participate in this study than those without them. Based on the COVID Symptom Study, in which more than 4 million people in the US, UK and Sweden have entered their symptoms after a COVID-19 diagnosis, postacute COVID-19 is defined as the presence of symptoms extending beyond 3 weeks from the initial onset of symptoms and chronic COVID-19 as extending beyond 12 weeks. Shared Decision Making and CommunicationĬurrently, there is no consensus definition of postacute COVID-19.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience. ![]() Challenges in Clinical Electrocardiography. ![]()
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