Abstract / Summary
Abstract Background Although the incidence of SARS‑CoV‑2 infections has declined, post‑COVID remains a major public health challenge. Individuals with post‑COVID experience multisystem symptoms and prolonged functional impairment, placing a burden on both affected individuals and healthcare systems. Symptom‑based clustering may identify more homogeneous subgroups and support efficient and appropriate care. This study aimed to identify symptom‑based clusters among individuals with post‑COVID and to examine associations with healthcare utilisation and long‑term health outcomes. Methods This multicentre cohort study included adults (≥ 18 years) with persistent symptoms following SARS‑CoV‑2 infection who were referred to post‑COVID outpatient clinics at three hospitals in the Netherlands. Symptom‑based clusters were identified using K‑means clustering based on reported post‑COVID symptoms at the initial visit. After a mean follow‑up of 2.5 years, all participants were invited to complete a digital questionnaire assessing current health status and quality-of-life. Patient characteristics, post‑COVID symptoms, healthcare utilisation, and long‑term health outcomes were described across clusters. Results Among the 1,155 patients in this cohort (67% female; median age 50 years; median time since infection 24.1 weeks), four symptom‑based clusters were identified. The Respiratory‑dominant & Dyspnoea cluster (47.7%) comprised 47.7% of the cohort, followed by the Fatigue‑dominant & Neurocognitive cluster (27.6%), the Fatigue‑dominant & Multisystem cluster (12.7%), and the Respiratory‑dominant & Airway‑Systemic cluster (11.9%). Patients in the fatigue‑dominant clusters were more frequently referred to occupational therapy, speech and language therapy, mental health services, or a rehabilitation programme than those in the respiratory‑dominant clusters (all p < 0.01), who more often received pharmacological treatment. At 2.5‑year follow‑up, the fatigue‑dominant clusters continued to show a higher disease burden, as reflected by worse PROM outcomes compared with the respiratory‑dominated clusters. Notably, anxiety and depression scores increased over time in all clusters. Conclusions This study shows that, despite the heterogeneity of the post‑COVID population, distinct symptom‑based groups can be identified. Clusters dominated by fatigue were characterised by higher healthcare utilisation and poorer long-term health outcomes. Notably, only 12% belonged to the group with predominant systemic symptoms. These findings may contribute to more tailored management strategies based on patients’ symptom profiles, thereby supporting effective care planning and earlier access to appropriate interventions.