Prevalence of physical frailty including risk factors up to one year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort study

PHOSP-COVID Study Collaborative Group, Hamish J C McAuley, Rachel A Evans, Charlotte E Bolton, Christopher E Brightling, James D Chalmers, Annemarie B Docherty, Omer Elneima, Paul L Greenhaff, Ayushman Gupta, Victoria C Harris, Ewen M Harrison, Ling-Pei Ho, Alex Horsley, Linzy Houchen-Wolloff, Caroline Jolley, Olivia C Leavy, Nazir I Lone, William D-C Man, Michael P MarksDhruv Parekh, Krisnah Poinasamy, Jennifer Quint, Betty Raman, Matthew Richardson, Ruth M Saunders, Marco Sereno, Aarti Shikotra, Amisha Singapuri, Sally J Singh, Michael Steiner, Ai Lyn Tan, Louise V Wain, Carly Welch, Julie Whitney, Miles D Witham, Janet M Lord, Neil J Greening

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: The scale of COVID-19 and its well documented long-term sequelae support a need to understand long-term outcomes including frailty.
Methods: This prospective cohort study recruited adults who had survived hospitalisation with clinically diagnosed COVID-19 across 35 sites in the UK (PHOSP-COVID). The burden of frailty was objectively measured using Fried’s Frailty Phenotype (FFP). The primary outcome was the prevalence of each FFP group; robust (no FFP criteria), pre-frail (one or two FFP criteria) and frail (three or more FFP criteria) at 5 months and 1 year after discharge from hospital. For inclusion in the primary analysis, participants required complete outcome data for three of the five FFP criteria. Longitudinal changes across frailty domains are reported at 5 months and 1 year post-hospitalisation, along with risk factors for frailty status. Patient-perceived recovery and health-related quality of life (HRQoL) were retrospectively rated for pre-COVID-19 and prospectively rated at the 5 month and 1 year visits. This study is registered with ISRCTN, number ISRCTN10980107.
Findings: Between March 5,2020 and March 31, 2021, 2,419 participants were enrolled with FFP data. Mean age was 57·9 (SD 12·6) years, 933 (38·6%) were female, and 429 (17·7%) had received invasive mechanical ventilation (IMV). 1,785 had measures at both timepoints, of which 240 (13·4%), 1138 (63·8%) and 407 (22·8%) were frail, pre-frail and robust respectively at 5 months compared with 123 (6·9%), 1,046 (58·6%) and 616 (34·5%) at 1 year. Factors associated with pre-frailty or frailty were IMV, older age, female sex, and greater social deprivation. Frail participants had a larger reduction in HRQoL compared with before their COVID-19 illness and were less likely to describe themselves as recovered.
Interpretation: Physical frailty and pre-frailty are common following hospitalisation with COVID-19. Improvement in frailty was seen between five and 12 months although two-thirds of the population remained pre-frail or frail. This suggests comprehensive assessment and interventions targeting pre-frailty and frailty beyond the initial illness are required.
Original languageEnglish
Article number101896
Publication statusPublished - 10 Mar 2023


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