Is post-acute sequelae COVID-19 (Long-COVID) a post-viral postural orthostatic tachycardia syndrome?

ABSTRACT

Objectives: To compare autonomic function and health-related quality of life (HRQoL) in those with post-acute sequelae of Covid-19 (PASC), postural orthostatic tachycardia syndrome (POTS) and healthy controls. Method(s) A total of 60 participants were recruited (PASC = 20, POTS = 20, controls = 20). There were no significant differences in age or other demographics between groups. PASC was defined as >=3 months of persistent unexplained symptomology post SARS-CoV-2 infection. 10-minute active standing test was undertaken using Finapres NOVA to measure beat-to-beat haemodynamic response. Composite Autonomic Symptom Score (COMPASS-31) was used to assess autonomic symptomology and the Euroquol 5-Dimension (EQ-5D) survey to assess HRQoL (scale of 0-1 with '1' representing full health). The 5-point hypermobility questionnaire (5-PHQ) was used to assess generalized joint hypermobility (defined as score >=2). Result(s) 95% of PASC subjects fulfilled the standing test criteria for POTS (DELTA heart rate, bpm 42 +/- 10 vs. 48 +/- 14 in POTS and 16 +/- 6 in controls;p < 0.001) and significantly increased autonomic symptoms per COMPASS-31 score as compared to controls (39 +/- 11 vs. 51 +/- 15 in POTS and 12 +/- 14 in controls;p < 0.001). Individuals with PASC and POTS had higher rates of joint hypermobility than controls (45% vs. 75% vs. 25% respectively;p = 0.006) and significantly reduced HRQoL utility scores (0.61 +/- 0.04 vs. 0.64 +/- 0.03 vs. 0.94 +/- 0.09 respectively;p < 0.001). Conclusion(s) Autonomic dysfunction and reduced HRQoL is prevalent in sufferers with PASC and bear high similarity to those with POTS. This is in keeping with the often-observed post-viral illness-mediated POTS. Our data calls for routine involvement of autonomic physicians in the care of subjects with PASC.