<scp>Multi‐disciplinary</scp> collaborative consensus guidance statement on the assessment and treatment of autonomic dysfunction in patients with <scp>post‐acute</scp> sequelae of <scp>SARS‐CoV</scp>‐2 infection (<scp>PASC</scp>)

Blitshteyn, Svetlana; Whiteson, Jonathan; Abramoff, Benjamin A.; Azola, Alba; Bartels, Matthew N.; Bhavaraju‐Sanka, Ratna; Chung, Tae Hwan; Fleming, Talya K.; Henning, Ellen; Miglis, Mitchell G.; Sampsel, Sarah; Silver, Julie K.; Tosto, Jenna; Verduzco‐Gutierrez, Monica; Putrino, David

doi:10.1002/pmrj.12894

Cited by 30 publications

(25 citation statements)

References 148 publications

(277 reference statements)

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“…Consistently with the open literature, in the present study, the main symptoms experienced by patients at the second follow up were shortage of breath, fatigue, anosmia, and ageusia [ 7 , 20 , 28 , 30 , 35 , 36 , 37 ].…”

Section: Discussionsupporting

confidence: 91%

Persistence of Symptoms 15 Months since COVID-19 Diagnosis: Prevalence, Risk Factors and Residual Work Ability

Sansone

Tassinari

Valentinotti³

et al. 2022

Life

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Background: A proportion of patients’ ailments may last after recovering from acute COVID-19, with episodic and systemic symptoms of unclear etiology potentially involving different organs. Study aim: The aim of this study was to investigate the persistence of symptoms 15 months since COVID-19 diagnosis in patients referring to the post-COVID-19 clinic in Trieste (north-eastern Italy). Methods: Two-hundred-forty-seven patients were medically examined between 8 December 2020–6 April 2021, after a median time of 49 days since first positive swab test for SARS-CoV-2. After a median time of 15 months since COVID-19 diagnosis, the same patients were contacted over the phone and investigated by standardized questionnaire collecting information on any persisting symptoms and work ability index (WAI). Four multivariable logistic regression models were fitted to investigate factors associated with persistence of any respiratory, neurological, dysautonomic, or psychiatric symptoms at first (median time 49 days since COVID-19 diagnosis) as well as second (median 15 months since COVID-19 diagnosis) follow up. A multiple linear regression was also employed to investigate factors associated with higher mean WAI, assessed only at second follow up. Additionally, factors associated with persistence of symptoms 200+ days since COVID-19 diagnosis between first and second follow-up were investigated by multivariable Generalized Estimating Equation (GEE). Results: At first follow up (median time of 49 days since COVID-19 diagnosis) symptoms more frequently reported were fatigue (80.2%), shortness of breath (69.6%), concentration deficit (44.9%), headache (44.9%), myalgia (44.1%), arthralgia (43.3%), and anosmia (42.1%). At second follow-up (median time of 15 months since COVID-19 diagnosis) 75% patients returned to their baseline status preceding COVID-19. At first follow up males were less likely to experience neurological (OR = 0.16; 95% CI: 0.08; 0.35) as well as psychiatric (OR = 0.43; 95% CI: 0.23; 0.80) symptoms as compared to females. At first follow up, the risk of neurological symptoms increased also linearly with age (OR = 1.04; 95% CI: 1.01; 1.08) and pre-existing depression was a major risk factor for persisting dysautonomic (aOR = 6.35; 95% CI: 2.01; 20.11) as well as psychiatric symptoms (omitted estimate). Consistently, at second follow up only females experience psychiatric symptoms, whereas males exhibited significantly higher mean WAI (RC = 0.50; 95% CI: 0.11; 0.88). Additionally, neurological symptoms at second follow up were more likely in patients with pre-existing comorbidities (OR = 4.31; 95% CI: 1.27; 14.7). Finally, persistence of symptoms lasting 200+ days since COVID-19 diagnosis increased linearly with age (OR = 1.03; 95% CI 1.01–1.05) and were more likely in patients affected by pre-existing depression (OR = 2.68; 95% CI 1.60; 4.49). Conclusions: Following a median time of 15 months since first positive swab test, 75% patients with symptoms returned to their baseline health status preceding COVID-19. Females had a significantly lower WAI and were more likely to experience psychiatric symptoms at second follow up (15 months since COVID-19 diagnosis). Furthermore, the risk of symptoms persisting 200+ days since COVID-19 diagnosis increased with history of depression, endorsing the hypothesis that long-COVID-19 symptoms may be at least partially explained by pre-existing psychological conditions. Patient rehabilitation and psychological support may therefore play a key role in caring patients with the so called long COVID-19 syndrome.

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Section: Discussionsupporting

confidence: 91%

Persistence of Symptoms 15 Months since COVID-19 Diagnosis: Prevalence, Risk Factors and Residual Work Ability

Sansone

Tassinari

Valentinotti³

et al. 2022

Life

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“…, 140. ], it is a significant cause of symptom burden for patients with Long COVID and consensus guidelines for management have been developed [ 37 ]. Patients with Long COVID display high rates of symptoms consistent with dysautonomia, such as orthostatic intolerance, fatigue, palpitations, cognitive impairment, nausea, and temperature dysregulation [ 34 , 141 ].…”

Section: Pathophysiology Of Long Covidmentioning

confidence: 99%

“…These treatments have been shown to be harmful and/or ineffective and several guidelines explicitly advise against them [ 36 , 218 ]. Once the patient has been subtyped, symptomatic treatment should be offered depending on the presentation [ 13 ], such as antihistamines for MCAS [ 219 ], and cardiac rate-limiting medication for dysautonomia [ 37 , 220 ]. The response to therapy should be reviewed on a regular basis, with treatments titrated/stopped/substituted as appropriate.…”

Section: Prioritiesmentioning

confidence: 99%

Long COVID: pathophysiological factors and abnormalities of coagulation

Turner¹,

Khan²,

Putrino³

et al. 2023

Trends in Endocrinology & Metabolism

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“…Blitshteyn and colleagues led additional multidisciplinary recommendations for evaluating and treating PASC-related autonomic dysfunction, and their consensus guidance was published in 2022 and is now accessible [ 63 ]. In our preliminary study looking at 42 patients with PASC-related autonomic dysfunction, despite treatments, they continue to be symptomatic at 1 year since PASC onset with mild to moderate improvement of their symptoms.…”

Section: Treatmentmentioning

confidence: 99%