Majority of Patients With Long COVID Meet Criteria for POTS

(This article originally appeared on our sister publication's website: https://www.contagionlive.com/view/majority-of-patients-with-long-covid-meet-criteria-for-pots)

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A new study found that (79%) of those with Post-acute sequelae of Covid-19 (PASC) or Long COVID met the internationally established criteria for POTS.

The study was published in The American Journal of Medicine.

“Overall, 79% (n=26) of PASC participants met the diagnostic criteria for POTS based on delta heart rate from the active standing test,” the investigators wrote. “Five other participants with PASC (15%) narrowly missed the 30 bpm cut-off with sustained delta heart rate between 25-29 bpm despite demonstrating postural symptoms. Two of these participants showed a transient systolic blood pressure drop of greater than 20 mmHg within the first minute of standing which resolved by the third minute.”

Patients aged 18 years and older who had PASC and POTS, who had presented at a specialist cardiology clinic were invited to participate in a prospective comparative study. A total of 99 participants were included in 3 groups: 33 with PASC, 33 with POTS, and 33 were in the healthy controls cohort.

According to the investigators, participants were subject to autonomic testing included beat-to-beat hemodynamic monitoring to assess respiratory sinus arrhythmia, Valsalva ratio and orthostatic changes during a 10-minute active standing test as well as Sudomotor assessment. The Composite Autonomic Symptom Score (COMPASS-31) was used to assess symptoms and the Euroquol 5-Dimension survey (EQ-5D-5L) was used to assess health-related quality of life (HrQoL) measures, they explained.

POTS Defined
According to the National Institute of Neurological Disorders and Stroke, POTS is characterized as, “one of a group of disorders that have orthostatic intolerance (OI) as their primary symptom. OI is a condition in which an excessively reduced volume of blood returns to the heart after an individual stands up from a lying down position. The primary symptom of OI is lightheadedness or fainting.”

It mostly affects women between the ages of 15-50 years of age, and the cause of the disorder is unknown.

POTS, COVID-19 and Vaccination
In another study, which was published in Nature Cardiovascular Research late last year, investigators pointed out the increased incidence rates in POTS for people who are vaccinated or who have had COVID-19.

“We show, in a cohort of 284,592 COVID-19-vaccinated individuals, using a sequence–symmetry analysis, that the odds of POTS are higher 90 days after vaccine exposure than 90 days before exposure; we also show that the odds for POTS are higher than referent conventional primary care diagnoses but lower than the odds of new POTS diagnosis after SARS-CoV-2 infection,” the investigators wrote.

They also reported that people who had COVID-19 were reported to have POTS at a rate 5 times higher than the incidence rates of POTS after COVID-19 vaccination.

The American Journal of Medicine authors see a connection between long COVID and POTS. “This study provides empirical evidence of the high prevalence of autonomic symptomology or POTS in those with PASC. The significant impairment in HrQOL and reduced health utility in those with PASC demands urgent attention from clinicians, healthcare services and governments to improve care in those affected.

They also noted a possibly correlation for COVID-19 as a possible trigger for dysautonomia.

“Notably, majority of participants with PASC in this study reported mild acute COVID-19 infection and the lag in the onset of autonomic symptoms by at least two weeks from acute infection lends further support to COVID-19 as a trigger for dysautonomia.”

Reference
Seeley MC, Gallagher C, Ong E. High incidence of autonomic dysfunction and postural orthostatic tachycardia syndrome in patients with long COVID: Implications for management and healthcare planning. June 28, 2023. doi:10.1016/j.amjmed.2023.06.010