ArticleBMJ open2026
Trajectory, healthcare utilisation and recovery in 3590 individuals with long covid: a 4-year prospective cohort analysis.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Cardiovascular Benefit and Gastrointestinal Risk of Colchicine in Secondary Prevention: Risk Associated with Dose and Treatment Duration.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2026Pooled it
- Integrated care pathway in individuals with Long COVID: STIMULATE-ICP, a cluster-randomized, phase 3 trial.Nature medicine · 2026Trial
- Article
- Exploring the implementation of a long COVID rehabilitation intervention: a mixed-methods process evaluation.BMC health services research · 2026Observational
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Authors and funding
20 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo characterise long-term trajectory of recovery in individuals with long covid.
designProspective cohort.
settingSingle-centre, specialist post-COVID service (London, UK).
participantsIndividuals aged ≥18 years with long covid (hospitalised and non-hospitalised) from April 2020 to March 2024.
main outcome measuresRoutine, prospectively collected data on symptoms, quality of life (including Fatigue Assessment Scale (FAS) and EuroQol 5 Dimensions (EQ-5D), return to work status and healthcare utilisation (investigations, outpatient and emergency attendances). The primary outcome was recovery by self-reported >75% of 'best health' (EQ-5D Visual Analogue Scale) and was assessed using Cox proportional hazards regression models over 4 years. Linked National Health Service England registry data provided secondary care healthcare utilisation and expenditure.
resultsWe included 3590 individuals (63.3% female, 73.5% non-hospitalised, median age 50.0 years, 71.9% with ≥2 doses of COVID-19 vaccination), who were followed up for a median of 136 (0-346) days since first assessment and 502 (251-825) days since symptom onset. At first assessment, 33.2% of employed individuals were unable to work. Dominant symptoms were fatigue (78.7%), breathlessness (68.1%) and brain fog (53.5%). 33.4% of individuals recovered to >75% of best health prior to clinic discharge (recovery occurred median 202 (94-468) days from symptom onset). Vaccinated individuals were more likely to recover faster (pre: HR 2.93 (2.00-4.28) and post: HR 1.34 (1.05-1.71) COVID-19 infection), whereas recovery hazard was inversely associated with FAS (HR 0.37 (0.33-0.42)), myalgia (HR 0.59 (0.45-0.76)) and dysautonomic symptoms (HR 0.46 (0.34-0.62)). There was high secondary care healthcare utilisation (both emergency and outpatient care). Annual inpatient and outpatient expenditure was significantly lower in hospitalised individuals while under the service. When compared with the prereferral period, emergency department attendances were reduced in non-hospitalised patients with long covid, but outpatient costs increased.
conclusionsIn the largest long covid cohort from a single specialist post-COVID service to date, only one-third of individuals under follow-up achieved satisfactory recovery. Fatigue severity and COVID-19 vaccination at presentation, even after initial COVID-19 infection, was associated with long covid recovery. Ongoing service provision for this and other post-viral conditions is necessary to support care, progress treatment options and provide capacity for future pandemic preparedness. Research and clinical services should emphasise these factors as the strongest predictors of non-recovery.
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