There is emerging evidence of long-term sequelae in a considerable proportion of COVID-19 patients after recovery and the spectrum and severity of such sequelae should be systematically reviewed. This review aims to evaluate the available evidence of all intermediate and long-term COVID-19 sequelae affecting formerly healthy adults. A systematic literature search of Embase, WHO, Scopus, Pubmed, Litcovid, bioRxiv and medRxiv was conducted with a cutoff date of the 17th September 2020 according to PRISMA guidelines and registered in PROSPERO (CRD42020208725). Search terms included “COVID-19”, “coronavirus disease 2019”, “SARS-CoV-2”, “sequelae” and “consequence*”. Publications on adult participants, with a confirmed SARS-CoV-2 infection were included. Elderly (>50 years old) and children (<18 years old) were excluded. Bias assessment was performed using a modified Newcastle-Ottawa Scale. A total of 31 papers were included. Study types included prospective and retrospective cohort studies, cross-sectional studies and case reports. Sequelae persistence since infection spanned 14 days to three months. Sequelae included persistent fatigue (39–73% of assessed persons), breathlessness (39–74%), decrease in quality of life (44–69%), impaired pulmonary function, abnormal CT findings including pulmonary fibrosis (39–83%), evidence of peri-/perimyo-/myocarditis (3–26%), changes in microstructural and functional brain integrity with persistent neurological symptoms (55%), increased incidence of psychiatric diagnoses (5.8% versus 2.5–3.4% in controls), incomplete recovery of olfactory and gustatory dysfunction (33–36% of evaluated persons). A variety of organ systems are affected by COVID-19 in the intermediate and longer-term after recovery. Main sequelae include post-infectious fatigue, persistent reduced lung function and carditis. Careful follow-up post COVID 19 is indicated to assess and mitigate possible organ damage and preserve life quality.

Introduction: To reduce inappropriate polypharmacy, deprescribing should be part of patients’ regular care. Yet deprescribing is difficult to implement, as shown in several studies. Understanding patients’ attitudes towards deprescribing at the individual and country level may reveal effective ways to involve older adults in decisions about medications and help to implement deprescribing in primary care settings. In this study we aim to investigate older adults’ perceptions and views on deprescribing in different European countries. Specific objectives are to investigate the patients’ willingness to have medications deprescribed by medication type and to have herbal or dietary supplements reduced or stopped, the role of the Patient Typology (on medication perspectives), and the impact of the patient-GP relationship in these decisions. Methods and analysis: This cross-sectional survey study has two parts: Part A and Part B. Data collection for Part A will take place in nine countries, in which per country 10 GPs will recruit 10 older patients (≥65 years old) each (n = 900). Part B will be conducted in Switzerland only, in which an additional 35 GPs will recruit five patients each and respond to a questionnaire themselves, with questions about the patients’ medications, their willingness to deprescribe those, and their patient-provider relationship. For both Part A and part B, a questionnaire will be used to assess the willingness of older patients with polypharmacy to have medications deprescribed and other relevant information. For Part B, this same questionnaire will have additional questions on the use of herbal and dietary supplements. Discussion: The international study design will allow comparisons of patient perspectives on deprescribing from different countries. We will collect information about willingness to have medications deprescribed by medication type and regarding herbal and dietary supplements, which adds important information to the literature on patients’ preferences. In addition, GPs in Switzerland will also be surveyed, allowing us to compare GPs’ and patients’ views and preferences on stopping or reducing specific medications. Our findings will help to understand patients’ attitudes towards deprescribing, contributing to improvements in the design and implementation of deprescribing interventions that are better tailored to patients’ preferences.

Background: Deprescribing reduces potentially harmful or unnecessary medications in older adults. Successful implementation requires understanding both patient and provider perspectives, although few studies have compared their preferences. Objective: To examine general practitioner (GP) and patient preferences for deprescribing and medication-related decision-making by investigating factors associated with preference concordance and the relationship with patient-provider trust. Design: Cross-sectional survey study conducted in primary care settings within the German-speaking region of Switzerland. Participants: Sixty-five patients aged ≥ 65 years taking ≥ 5 medications and their 10 GPs completed questionnaires. Main Measures: Patient and GP preferences for deprescribing medications were assessed through two questions; for patients: “Thinking about your current medication list, are there any medications that you would like to stop taking or reduce the dose of?” and for GPs: “Would you stop or reduce the dose of any of the medications that the patient is currently taking?” We assessed concordance between GPs’ and patients’ deprescribing preferences and analyzed associations between trust and deprescribing preferences using univariate Generalized Estimating Equations with Poisson distribution and finite-sample correction, accounting for clustering at the GP level. Key Results: Similar proportions of patients (38%) and GPs (35%) wanted to deprescribe at least one medication, but only eight GP-patient dyads wanted to deprescribe, with just one dyad selecting the same medication. The most frequently identified medications to deprescribe were dietary supplements ( GPs = 11/42, 26%; patients = 4/35, 11%), cardiovascular system medications ( GPs = 9/42, 21%; patients = 15/35, 43%), and nervous system medications ( GPs = 8/42, 19%; patients = 9/35, 26%). GPs’ primary reason for not deprescribing was believing patients wanted to continue their medications (83%), while patients believed doctors only prescribe necessary ones (38%). Conclusions: Despite similar interest in deprescribing, GPs and patients rarely selected the same medications to stop. These findings suggest that clear discussions about medication necessity and preferences could improve deprescribing decisions.

Background: Dietary supplements are commonly used by older adults, but their inappropriate use may lead to adverse events. To optimise medication use, general practitioners (GPs) ideally are aware of all substances that patients use, including supplements. This cross-sectional study explored the use of dietary supplements by older patients with polypharmacy, the rate at which they disclosed this use to their GPs, and compared patients’ and GPs’ attitudes towards discontinuing dietary supplements. Methods: Ten GPs in Swiss primary care recruited five to ten of their older patients taking ≥ 5 regular medications. Both GPs and their patients completed a survey on patients’ use of dietary supplements and attitudes towards deprescribing those. We described and compared their responses. We assessed the association of supplement disclosure with patient characteristics using multilevel logistic regression analysis. Results: Three out of ten GPs (30%) were female, and GPs’ average age was 52 years (SD = 8). 45% of patients were female (29/65). Most patients (n = 45, 70%) were taking ≥ 1 supplement. On average, patients reported to be using three supplements (SD = 2). In 60% (n = 39) of patients, GPs were unaware of ≥ 1 supplement used. We did not find evidence for an association between supplement disclosure to GPs and patient characteristics. Only 8% (n = 5) of patients and 60% (n = 6) of GPs reported ≥ 1 supplement they would be willing to deprescribe and none of the supplements reported by GPs and patients to deprescribe matched. Conclusion: Swiss GPs were unaware of many dietary supplements used by their older patients, which may affect medication optimisation efforts.

Understanding patients' perspectives on their medications is important to facilitate collaborative deprescribing and shared decision-making. To explore older patients' attitudes towards having their medications deprescribed and facilitators for deprescribing in Swedish primary care. Swedish primary care patients (≥ 65 years and taking ≥5 medications) responded to an anonymous survey on their attitudes towards deprescribing (June 2022-December 2023). Out of 101 patients (45% women), 81% were satisfied with their medications (n = 82), 78% would be willing to stop or reduce ≥1 medication if their physician said it was possible (n = 79), and 27% (n = 27) wanted to deprescribe ≥1 medications from their medication lists (with 48 unique medications being mentioned). Side effects associated with the medication was the most commonly stated reason for wanting to deprescribe, mentioned by 52% (14/27 patients). Patients most often wanted to deprescribe blood glucose lowering medications, mentioned by 26% (7/27 patients). Most frequent patient-perceived facilitators for deprescribing were the support from their general practitioner (GP) (68%), a plan for deprescribing (38%), the possibility of restarting the medication if needed (23%), and having an alternative medication (22%). While most older adults with polypharmacy in Swedish primary care would be willing to deprescribe if suggested by their physician, many did not want to have any medication deprescribed. This difference highlights the need to clarify patients' preferences when discussing medication changes. Support from the GP was identified as an important facilitator, demonstrating the importance of patient-GP communication and shared decision-making in deprescribing.