tetano
Editor, Senior Moderator
Eur J Neurol
. 2023 Mar 15.
doi: 10.1111/ene.15787. Online ahead of print.
Impact of the COVID-19 pandemic on clinical autonomic practice in Europe A survey of the European Academy of Neurology (EAN) and the European Federation of Autonomic Societies (EFAS)
Alessandra Fanciulli[SUP] 1 [/SUP], Fabian Leys[SUP] 1 [/SUP], Magdalena Krbot Skorić[SUP] 2 3 [/SUP], Diogo Reis Carneiro[SUP] 4 5 [/SUP], Giovanna Calandra-Buonaura[SUP] 6 7 [/SUP], Jennifer Camaradou[SUP] 8 9 [/SUP], Giacomo Chiaro[SUP] 10 11 [/SUP], Pietro Cortelli[SUP] 6 7 [/SUP], Cristian Falup-Pecurariu[SUP] 12 [/SUP], Roberta Granata[SUP] 1 [/SUP], Pietro Guaraldi[SUP] 6 [/SUP], Raimund Helbok[SUP] 1 13 [/SUP], Max J Hilz[SUP] 14 15 [/SUP], Valeria Iodice[SUP] 10 11 [/SUP], Jens Jordan[SUP] 16 17 [/SUP], Evert C A Kaal[SUP] 18 [/SUP], Anita Kamondi[SUP] 19 20 [/SUP], Anne Pavy Le Traon[SUP] 21 [/SUP], Isabel Rocha[SUP] 22 [/SUP], Johann Sellner[SUP] 23 24 [/SUP], Jean Michel Senard[SUP] 25 [/SUP], Astrid Terkelsen[SUP] 26 [/SUP], Gregor K Wenning[SUP] 1 [/SUP], Elena Moro[SUP] 27 [/SUP], Thomas Berger[SUP] 28 29 [/SUP], Roland D Thijs[SUP] 30 31 [/SUP], Walter Struhal[SUP] 32 [/SUP], Mario Habek[SUP] 2 33 [/SUP]; Collaborators of European Network of Neurological ANS laboratories
Affiliations
Abstract
Objective: To investigate the impact of the coronavirus-disease-2019 (COVID-19) pandemic on European clinical autonomic practice.
Methods: Eighty-four neurology-driven or interdisciplinary autonomic centers in 22 European countries were invited to fill in a web-based survey between September and November 2021.
Results: Forty-six centers completed the survey (55%). During the first pandemic year, the number of performed tilt-table tests, autonomic outpatient and inpatient visits decreased respectively by 50%, 45% and 53%, and every-third center reported major adverse events due to postponed examinations or visits. The most frequent newly-diagnosed or worsened cardiovascular autonomic disorders after COVID-19 infection included postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and recurrent vasovagal syncope, deemed likely related to the infection by ≥50% of the responders. Forty-seven percent of the responders also reported about people with new-onset of orthostatic intolerance, but negative tilt-table findings, and 16% about people with psychogenic pseudosyncope after COVID-19. Most patients were treated non-pharmacologically and symptomatic recovery at follow-up was observed in ≥45% of cases. By contrast, low frequencies of newly-diagnosed cardiovascular autonomic disorders following COVID-19 vaccination were reported, most frequently POTS and recurrent vasovagal syncope, and most of the responders judged a causal association unlikely. Non-pharmacological measures were the preferred treatment choice, with 50-100% recovery rates at follow-up.
Conclusions: Cardiovascular autonomic disorders may develop or worsen following a COVID-19 infection, while the association with COVID-19 vaccines remains controversial. Despite the severe pandemic impact on European clinical autonomic practice, a specialized diagnostic work-up was pivotal to identify non-autonomic disorders in people with post-COVID-19 orthostatic complaints.
Keywords: COVID-19 infection; COVID-19 vaccination; POTS; autonomic nervous system; orthostatic hypotension; postural orthostatic tachycardia syndrome; syncope; telemedicine.
. 2023 Mar 15.
doi: 10.1111/ene.15787. Online ahead of print.
Impact of the COVID-19 pandemic on clinical autonomic practice in Europe A survey of the European Academy of Neurology (EAN) and the European Federation of Autonomic Societies (EFAS)
Alessandra Fanciulli[SUP] 1 [/SUP], Fabian Leys[SUP] 1 [/SUP], Magdalena Krbot Skorić[SUP] 2 3 [/SUP], Diogo Reis Carneiro[SUP] 4 5 [/SUP], Giovanna Calandra-Buonaura[SUP] 6 7 [/SUP], Jennifer Camaradou[SUP] 8 9 [/SUP], Giacomo Chiaro[SUP] 10 11 [/SUP], Pietro Cortelli[SUP] 6 7 [/SUP], Cristian Falup-Pecurariu[SUP] 12 [/SUP], Roberta Granata[SUP] 1 [/SUP], Pietro Guaraldi[SUP] 6 [/SUP], Raimund Helbok[SUP] 1 13 [/SUP], Max J Hilz[SUP] 14 15 [/SUP], Valeria Iodice[SUP] 10 11 [/SUP], Jens Jordan[SUP] 16 17 [/SUP], Evert C A Kaal[SUP] 18 [/SUP], Anita Kamondi[SUP] 19 20 [/SUP], Anne Pavy Le Traon[SUP] 21 [/SUP], Isabel Rocha[SUP] 22 [/SUP], Johann Sellner[SUP] 23 24 [/SUP], Jean Michel Senard[SUP] 25 [/SUP], Astrid Terkelsen[SUP] 26 [/SUP], Gregor K Wenning[SUP] 1 [/SUP], Elena Moro[SUP] 27 [/SUP], Thomas Berger[SUP] 28 29 [/SUP], Roland D Thijs[SUP] 30 31 [/SUP], Walter Struhal[SUP] 32 [/SUP], Mario Habek[SUP] 2 33 [/SUP]; Collaborators of European Network of Neurological ANS laboratories
Affiliations
- PMID: 36920252
- DOI: 10.1111/ene.15787
Abstract
Objective: To investigate the impact of the coronavirus-disease-2019 (COVID-19) pandemic on European clinical autonomic practice.
Methods: Eighty-four neurology-driven or interdisciplinary autonomic centers in 22 European countries were invited to fill in a web-based survey between September and November 2021.
Results: Forty-six centers completed the survey (55%). During the first pandemic year, the number of performed tilt-table tests, autonomic outpatient and inpatient visits decreased respectively by 50%, 45% and 53%, and every-third center reported major adverse events due to postponed examinations or visits. The most frequent newly-diagnosed or worsened cardiovascular autonomic disorders after COVID-19 infection included postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and recurrent vasovagal syncope, deemed likely related to the infection by ≥50% of the responders. Forty-seven percent of the responders also reported about people with new-onset of orthostatic intolerance, but negative tilt-table findings, and 16% about people with psychogenic pseudosyncope after COVID-19. Most patients were treated non-pharmacologically and symptomatic recovery at follow-up was observed in ≥45% of cases. By contrast, low frequencies of newly-diagnosed cardiovascular autonomic disorders following COVID-19 vaccination were reported, most frequently POTS and recurrent vasovagal syncope, and most of the responders judged a causal association unlikely. Non-pharmacological measures were the preferred treatment choice, with 50-100% recovery rates at follow-up.
Conclusions: Cardiovascular autonomic disorders may develop or worsen following a COVID-19 infection, while the association with COVID-19 vaccines remains controversial. Despite the severe pandemic impact on European clinical autonomic practice, a specialized diagnostic work-up was pivotal to identify non-autonomic disorders in people with post-COVID-19 orthostatic complaints.
Keywords: COVID-19 infection; COVID-19 vaccination; POTS; autonomic nervous system; orthostatic hypotension; postural orthostatic tachycardia syndrome; syncope; telemedicine.