Prevalence and Clinical Impact of Postural Orthostatic Tachycardia Syndrome in Highly Symptomatic Long COVID, 2025, Björnson et al.

[SNT Gatchaman]

Prevalence and Clinical Impact of Postural Orthostatic Tachycardia Syndrome in Highly Symptomatic Long COVID

Spoiler: Authors

Mikael Björnson; Klara Wijnbladh; Anna Törnberg; Anna Svensson-Raskh; Annie Svensson; Marcus Ståhlberg; Michael Runold; Artur Fedorowski; Malin Nygren Bonnier; Judith Bruchfeld

BACKGROUND
The incidence of postural orthostatic tachycardia syndrome (POTS) in long COVID has been a growing concern since the first cases were reported in 2021. The aim of this study was to assess the prevalence and clinical impact of POTS in a series of well-characterized patients with long COVID.

METHODS
We prospectively analyzed 467 nonhospitalized, highly symptomatic (sick leave ≥50%) patients with long COVID, and studied differences in demographics and clinical assessment outcomes between those diagnosed with POTS and the remaining long COVID patients. Examinations were performed at a median of 12 months after acute COVID-19, followed by a cardiologist evaluation with 48-hour ECG, head-up tilt test, and Active Stand Test for those with clinically suspected POTS.

RESULTS
Of all long COVID patients, 143 (31%) were diagnosed with POTS, 128 (27%) did not fulfill POTS criteria, while 196 (42%) had no clinical signs of POTS. Patients with POTS were younger (mean age, 40.0 versus 44.0 versus 47.0 years, respectively; P≤0.001) and predominantly female (91%). They had significantly lower physical activity compared with the other 2 groups, as measured with the Frandin-Grimby scale (P=0.001). Heart rates during the 6-minute walk test were significantly higher in the POTS group, both during walking and at rest afterward, with a significantly shorter walking distance (448 m versus 472 m versus 509 m, respectively; P≤0.001). However, the distribution of symptoms showed no significant differences between the groups.

CONCLUSIONS
In this cohort of predominantly younger women with highly symptomatic long COVID, POTS is common and presents with overlapping symptoms between POTS and non-POTS patients. Long COVID POTS confers lower physical activity and capacity compared with non-POTS long COVID and should be systematically assessed in this condition.

Web | Circulation: Arrhythmia and Electrophysiology | Paywall

 

[SNT Gatchaman]

Identified and requested by @Nightsong

 

[SNT Gatchaman]

We report a high prevalence of POTS in a cohort of highly symptomatic patients with long COVID, based on a structured follow-up including POTS-specific diagnostic tests.

we can confirm, in agreement with previous studies, that roughly one-third of highly symptomatic long COVID patients suffer from POTS, compared with an estimated prevalence of POTS in general population of 0.2% to 1%

The notable impact of POTS on self-rated health, physical activity and capacity in a cohort of already highly affected Long COVID patients is worth a comment. All groups had Frändin-Grimby scores concordant with an active lifestyle before disease onset, with no statistically significant initial differences between groups, followed by a significantly lower activity level for the (+)POTS group at follow-up compared with the (0) POTS group. The adjusted 6MWT distance was significantly lower in the (+)POTS group compared with both other groups. However, the absolute 6MWT distance showed no statistically significant difference between the (+)POTS- and the (−)POTS-group, the latter with symptoms suggesting POTS but not meeting the diagnostic criteria. Hypothetically, these patients may suffer from lower-grade autonomic dysfunction being in the intermediate zone between POTS and non-POTS long COVID patients.

In our cohort, the prevalence of comorbidities and history of psychiatric illness lies well within or below the range of the Swedish population as a whole. In contrast, test results related to physiological performance and well-being are markedly lower for the whole long COVID patient group: all groups achieved shorter walking distances than reference values adjusted for age, sex, and BMI. The EQVAS mean score was 40.61(SD 18.53), while a population-based Swedish score is 77.0 for women and 80.4 for men in the same age groups.

 

[Utsikt]

However, the absolute 6MWT distance showed no statistically significant difference between the (+)POTS- and the (−)POTS-group, the latter with symptoms suggesting POTS but not meeting the diagnostic criteria. Hypothetically, these patients may suffer from lower-grade autonomic dysfunction being in the intermediate zone between POTS and non-POTS long COVID patients.

When you insist on using the arbitrary diagnostic criteria of POTS, that’s what you end up with. If you consider OI instead, regardless of HR change upon standing, you might be able to make more sense of the data..

 

[Dolphin]

https://www.eurekalert.org/news-releases/1100722

NEWS RELEASE 3-OCT-2025

POTS common in patients with long COVID​

Peer-Reviewed Publication
KAROLINSKA INSTITUTET



A new study from Karolinska Institutet in Sweden shows that an unusual heart rhythm disorder, POTS, is particularly common in people with long COVID. The majority of those affected are middle-aged women. The study has been published in the scientific journal Circulation: Arrhythmia and Electrophysiology.

Postural orthostatic tachycardia syndrome, or POTS, is a condition where the heart beats abnormally fast when changing position from lying down to standing up. Standing up is a challenge for those affected who feel dizzy and would rather sit or lie down, so called orthostatic intolerance. Their hearts may also beat faster than normal at rest and during exertion. Patients experience fatigue and difficulties concentrating, symptoms that are common in long COVID.

Now, researchers at Karolinska Institutet show that POTS occurs in almost a third of patients with severe long COVID. By comparison, less than one per cent of the Swedish population was affected by POTS before the pandemic.

“Previous, smaller studies have shown that there is a connection, but now we can say with certainty that POTS is a very common condition in patients with long COVID. This is valuable knowledge for both healthcare professionals and patients,” says Mikael Björnson, doctoral student at the Department of Medicine, Solna, Karolinska Institutet.

Women in their early middle age

According to the researchers, this study is the largest and most detailed to date on the link between POTS and long COVID. A total of 467 patients with severe long COVID who had not been hospitalised for COVID-19 were examined. Ninety-one per cent were middle-aged women who were essentially healthy and physically active before they developed long COVID. At an average of twelve months after falling ill, they underwent physical tests and completed forms about their health. Those who showed signs of possible POTS also received an assessment from a cardiologist after further, targeted tests.

Thirty-one per cent of participants received a POTS diagnosis, while 27 per cent had symptoms but did not meet the criteria for diagnosis. The remaining 42 per cent had no symptoms of POTS. Patients with a diagnosis had significantly higher heart rates during walking tests and reported lower health-related quality of life.

POTS can be treated

“It is important to know that POTS can be detected with inexpensive, simple tests that are available at all levels of healthcare. For those who receive a diagnosis, there are treatments that can alleviate symptoms and improve quality of life,” says Judith Bruchfeld, associate professor at Karolinska Institutet, senior consultant in infectious diseases at Karolinska University Hospital and head of the study.

The researchers now recommend that patients with long COVID who experience a significant increase in heart rate when changing position from lying down to standing, as well as during exertion, and who experience symptoms such as dizziness, brain fog and pronounced fatigue, are investigated for POTS.

The next step in the research is a four- and five-year follow-up of the patient group, and in addition, patients with COVID-19 who have been treated in hospital. The researchers will investigate recovery and functional level over time.

The study is a collaboration with Karolinska University Hospital and has been funded by the Swedish Research Council and the Swedish Heart-Lung Foundation.

Publication: "Prevalence and Clinical Impact of Postural Orthostatic Tachycardia Syndrome in Highly Symptomatic Long COVID". Björnson M, Wijnbladh K, Törnberg A, Svensson-Raskh A, Svensson A, Ståhlberg M, Runold M, Fedorowski A, Nygren Bonnier M, Bruchfeld J. Circulation: Arrhythmia and Electrophysiology, online 30 September 2025, doi: 10.1161/CIRCEP.124.013629.

JOURNAL​

Circulation Arrhythmia and Electrophysiology

DOI​

10.1161/CIRCEP.124.013629

METHOD OF RESEARCH​

Observational study

SUBJECT OF RESEARCH​

People

ARTICLE TITLE​

Prevalence and Clinical Impact of Postural Orthostatic Tachycardia Syndrome in Highly Symptomatic Long COVID

ARTICLE PUBLICATION DATE​

30-Sep-2025

 

[Utsikt]

For those who receive a diagnosis, there are treatments that can alleviate symptoms and improve quality of life,” says Judith Bruchfeld, associate professor at Karolinska Institutet, senior consultant in infectious diseases at Karolinska University Hospital and head of the study.

And those treatments are?