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One-Year outcomes and health care utilization in survivors of severe acute respiratory syndrome

Tansey, C.M., Louie, M., Loeb, M., Gold, W.L., Muller, M.P., De Jager, J., Cameron, J.I., Tomlinson, G., Mazulli, T., Walmsley, S.L., Rachlis, A.R., Mederski, B.D., Silverman, M., Shainhouse, Z., Ephtimios, I.E., Avendano, M., Downey, J., Styra, R., Yamamura, D., Gerson, M., Stanbrook, M.B., Marras, T.K., Phillips, E.J., Zamel, N., Richardson, S.E., Slutsky, A.S. and Herridge, M.S. (2007) One-Year outcomes and health care utilization in survivors of severe acute respiratory syndrome. Archives of Internal Medicine, 167 (12). pp. 1312-1320.

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Background Severe Acute Respiratory Syndrome (SARS) became a global epidemic in 2003. Comprehensive information on 1-year outcomes and health care utilization is lacking. Research conducted during the SARS outbreak may help inform research planning for future public health emergencies. The objective of this study was to evaluate the 1-year outcomes in survivors of SARS and their family caregivers.

Method The study was prospective and observational. We evaluated 117 SARS survivors from Toronto, Ontario. Patients were interviewed and underwent physical examination, pulmonary function testing, chest radiography, a 6-minute-walk test, quality-of-life measures, and self-report of health care utilization. At 1 year, informal caregivers were identified for a survey on caregiver burden.

Results The enrolled survivors of SARS were young (median age, 42 years), and most were women (67%) and health care workers (65%). At 1 year after hospital discharge, pulmonary function measures were in the normal range, but 18% of patients had a significant reduction in distance walked in 6 minutes. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) domains were 0.3 to 1.0 SD below normal at 1 year. Of the patients, 17% had not returned to work by 1 year. Fifty-one patients required 668 visits to psychiatry or psychology practitioners. During the SARS epidemic, informal caregivers reported a decline of 1.6 SD below normal on the mental component score of the SF-36.

Conclusions Most SARS survivors had good physical recovery from their illness, but some patients and their caregivers reported a significant reduction in mental health 1 year later. Strategies to ameliorate the psychological burden of an epidemic on the patient and family caregiver should be considered as part of future pandemic planning.

Severe acute respiratory syndrome (SARS) became a global epidemic in 2003. Most cases were in Asia, and the largest concentration of North American cases occurred in Toronto, Ontario.1 Research efforts during and after the epidemic focused on the epidemiologic features of the illness,1- 2 the detailed characterization of the pathogen,3- 4 the clinical course,5- 10 and the short-term outcomes of the acute disease.11

The longer-term physical and psychological consequences of SARS were not reported until recently. Several investigations of these longer-term outcomes (>6 months) have focused on pulmonary function,12- 14 distance walked in 6 minutes,12 and health-related quality of life (QOL).12- 13 To date, in patients with SARS, there is little information on the pattern of return to work, exercise tolerance, or health care utilization after the SARS episode. Also, there have been no reports to our knowledge on the impact of this acute illness on the family caregiver. The goals of this study were to conduct a comprehensive and family-centered evaluation of the 1-year outcomes in survivors of SARS and their family caregivers.

Publication Type: Journal Article
Publisher: American Medical Association
Copyright: 2007 American Medical Association
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