# Gender Disparities in COVID-19 Survivors with Impaired Quality of Life, Effort Intolerance, and Cardiopulmonary Symptoms: A Prospective Cohort Study

## TL;DR

This study finds that while male COVID-19 patients face higher risks during hospitalization, female survivors experience worse long-term physical function and fatigue despite better heart function.

## Contribution

The study reveals gender-specific differences in both acute and post-acute outcomes of hospitalized COVID-19 patients.

## Key findings

- Males were more likely to require ICU and oxygen during hospitalization and had higher inflammatory markers.
- Females reported worse physical function and fatigue one year post-hospitalization and walked shorter distances.
- Females had higher ejection fractions and smaller infarct sizes on CMR despite worse functional outcomes.

## Abstract

Prior studies have suggested gender differences in COVID-related outcomes that have the potential to impact cardiovascular risk. We aimed to investigate gender differences on short- and long-term effects of COVID-19 infection.

Patients hospitalized with COVID-19 infection were enrolled in an ongoing prospective registry across NY-Presbyterian networks, which encompassed same-day echocardiogram, cardiac magnetic resonance (CMR), 6-minute walk test, and quality of life assessment 1 year following acute COVID hospitalization.

In this prospective cohort of 213 hospitalized patients with COVID-19 infection, males were more likely to require intensive care unit (ICU) stay (13.6 vs. 3.6%; p = 0.009) and oxygen supplementation (40.8 vs. 26.4%; p = 0.026), paralleling higher rates of elevated troponin, C-reactive protein, ferritin, and D-dimer (p < 0.05 for all). In contrast, 1 year following COVID hospitalization, females reported worse physical function and fatigue on Patient-Reported Outcomes Measurement Information System (PROMIS) scale (p < 0.05 for all). Additionally, 6-minute walk distance was less in females than males (383.0 ± 98.0 vs. 428.6 ± 78.6 m; p = 0.006), and Borg dyspnea score was nearly twofold higher in females vs. males (2.0 ± 2.3 vs. 1.0 ± 1.5; p < 0.001). With respect to imaging parameters, females had higher left ventricle and right ventricle ejection fraction (p < 0.05 for all) with smaller infarct size (p = 0.042) on CMR.

Whereas males have greater morbidity during acute COVID hospitalization, females are disproportionately impacted by post-COVID impaired functional status despite higher biventricular ejection fraction and smaller infarct size.