Prevalence of orthostatic intolerance in Long Covid clinic patients: a multicentre observational study

Lee, C. et al. (2024) Prevalence of orthostatic intolerance in Long Covid clinic patients: a multicentre observational study. Journal of Medical Virology, 96(3), e29486. (doi: 10.1002/jmv.29486) (PMID:38456315)

Abstract

Orthostatic intolerance (OI), including postural orthostatic tachycardia syndrome (PoTS) and orthostatic hypotension (OH), are often reported in long covid, but published studies are small with inconsistent results. We sought to estimate the prevalence of objective OI in patients attending long covid clinics and healthy volunteers and associations with OI symptoms and comorbidities. Participants with a diagnosis of long covid were recruited from eight UK long covid clinics, and healthy volunteers from general population. All undertook standardized National Aeronautics and Space Administration Lean Test (NLT). Participants' history of typical OI symptoms (e.g., dizziness, palpitations) before and during the NLT were recorded. Two hundred seventy-seven long covid patients and 50 frequency-matched healthy volunteers were tested. Healthy volunteers had no history of OI symptoms or symptoms during NLT or PoTS, 10% had asymptomatic OH. One hundred thirty (47%) long covid patients had previous history of OI symptoms and 144 (52%) developed symptoms during the NLT. Forty-one (15%) had an abnormal NLT, 20 (7%) met criteria for PoTS, and 21 (8%) had OH. Of patients with an abnormal NLT, 45% had no prior symptoms of OI. Relaxing the diagnostic thresholds for PoTS from two consecutive abnormal readings to one abnormal reading during the NLT, resulted in 11% of long covid participants (an additional 4%) meeting criteria for PoTS, but not in healthy volunteers. More than half of long covid patients experienced OI symptoms during NLT and more than one in 10 patients met the criteria for either PoTS or OH, half of whom did not report previous typical OI symptoms. We therefore recommend all patients attending long covid clinics are offered an NLT and appropriate management commenced.

• Item Type: Articles
• Additional Information: This work is independent researchfunded by the National Institute for Health and Care Research(NIHR) (Long Covid grant, Ref: COV‐LT2‐0016).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Scott, Dr Janet
• Authors: Lee, C., Greenwood, D. C., Master, H., Balasundaram, K., Williams, P., Scott, J. T., Wood, C., Cooper, R., Darbyshire, J. L., Espinosa Gonzalez, A., Davies, H. E., Osborne, T., Corrado, J., Iftekhar, N., Rogers, N., Delaney, B., Greenhalgh, T., Sivan, M., and the LOCOMOTION Consortium,
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Journal Name: Journal of Medical Virology
• Publisher: Wiley
• ISSN: 0146-6615
• ISSN (Online): 1096-9071
• Published Online: 08 March 2024
• Copyright Holders: Copyright © 2024 The Authors
• First Published: First published in Journal of Medical Virology 96(3):e29486
• Publisher Policy: Reproduced under a creative commons licence