Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study, 2024, Cassie Lee, Darren

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Preprint now published. See post #6

https://www.medrxiv.org/content/10.1101/2023.12.18.23299958v1

Prevalence of orthostatic intolerance in Long Covid clinic patients – A multicentre observational study

Cassie Lee1(0009-0004-9449-0932) Darren C Greenwood2, Harsha Master3, Kumaran Balasundaram4, Paul Williams3, Janet T. Scott5,6, Conor Wood7, Rowena Cooper5, Julie L. Darbyshire8, Ana Espinosa Gonzalez9, Helen E. Davies10, Thomas Osborne11, Joanna Corrado11, Nafi Iftekhar11, Natalie Rogers12, Brendan Delaney9, Trish Greenhalgh8, Manoj
Sivan11 on behalf of the LOCOMOTION Consortium

1 Imperial College Healthcare NHS Trust, London, UK
2 School of Medicine, University of Leeds, Leeds, UK
3 Covid assessment and rehabilitation service, Hertfordshire Community NHS Trust, Welwyn Garden City, UK
4 NIHR Leicester Biomedical Research Centre – Respiratory & Infection Theme, Glenfield Hospital, Leicester, UK
5 Development and Innovation Department, NHS Highlands, Inverness, UK.
6 MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
7 Birmingham Community Healthcare, Birmingham, UK
8 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
9 Faculty of Medicine, Department of Surgery & Cancer, Imperial College, London, UK
10 Department of Respiratory Medicine, University Hospital of Wales, Cardiff, UK
11 Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
12 Person with experience of long Covid and member of the LOCOMOTION Patient Advisory Group



Abstract

Purpose:

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 symptoms and comorbidities.

Methods:

Participants were recruited from 8 UK long covid clinics, and healthy volunteers from general population.

All undertook standardised National Aeronautics and Space Administration Lean Test (NLT).

Participants history of typical OI symptoms (e.g. dizziness, palpitations) prior to and during the NLT were recorded.

Results:

277 long covid patients and 50 frequency-matched healthy volunteers were tested.

Healthy volunteers had no history of OI symptoms or PoTS, 10% had asymptomatic OH. 130 (47%) long covid patients had previous history of OI symptoms and 144 (52%) developed symptoms during the NLT.

41 (15%) had 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 to one reading, resulted in 11% of long covid participants meeting criteria for PoTS, but not in healthy volunteers.

Conclusion:

More than half of long covid patients experienced OI symptoms during NLT and more than one in ten patients met the criteria for either PoTS or OH, half of whom did not report previous typical OI symptoms.

We recommend all patients attending long covid clinics are offered an NLT and appropriate management commenced.

https://twitter.com/user/status/1737212212068966670
Click to expand...
 
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Cohort characteristics:

277 Long-Covid patients, 50 healthy controls.

Contrary to many other studies, this study did very well in terms of not only recruiting elderly people (mean ages LC=48, HC=48) and they also did well w.r.t. sex distribution in their cohorts (62% females in LC vs 64% females in HC).

Unfortunately, the mean BMI could be somewhat problematic for a condition for which the common medical advice is exercise. LC patients had a mean BMI of 29 (SD=7) whilst HC had a mean BMI of 25 (SD=5). It would be lovely, if such studies would ensure to recruit less overweight patients or provide an analysis w.r.t. BMI as well.

Overall their LC patients don't have too many symptoms (only 9% have fatigue, 5% have breathlessness, 1% have muscle pain and even less than 1% have brain fog) whilst standing. Does that mean they aren't particularly sick or is that a consequence of asking them how they are feeling whilst perfoming the lean test (I expect the answer to "Do you have brain fog?" is a different one to "Does the lean test cause brain fog?")? Perhaps they could have used a severity scale or also reported the number of symptoms in general (not just during the lean test) to provide a decent overview of the patients and on how ill these patients are.

At least they did very well in recruiting patients that didn’t just recently become sick (average duration of LC is 18 months, with shortest duration being 14), but hospitalised patients are possibly somewhat overrepresented at 9%.

I still think it’s a decent study, but it’s also extremely disappointing that the best one can allegedly do after 4 years of research is measuring the difference in heart rate whilst standing and lying down. Hopefully, they can at least follow this up with a larger study, possibly with methods that have been studied in ME/CFS for over 10 years (tilt-table test, transcranial Doppler) as well as looking at pathophysiology.
 
Reformatted with links (for this week's News-in-Brief post)

Prevalence of orthostatic intolerance in Long Covid clinic patients – A multicentre observational study
Cassie Lee; Darren Greenwood; Harsha Master; Kumaran Balasundaram; Paul Williams; Janet Scott; Conor Wood; Rowena Cooper; Julie Darbyshire; Ana Espinosa Gonzalez; Helen Davies; Thomas Osborne; Joanna Corrado; Nafi Iftekhar; Natalie Rogers; Brendan C Delaney; Trish Greenhalgh; Manoj Sivan; LOCOMOTION Consortium

Purpose
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 symptoms and comorbidities.

Methods
Participants were recruited from 8 UK long covid clinics, and healthy volunteers from general population. All undertook standardised National Aeronautics and Space Administration Lean Test (NLT). Participants history of typical OI symptoms (e.g. dizziness, palpitations) prior to and during the NLT were recorded.

Results
277 long covid patients and 50 frequency-matched healthy volunteers were tested. Healthy volunteers had no history of OI symptoms or PoTS, 10% had asymptomatic OH. 130 (47%) long covid patients had previous history of OI symptoms and 144 (52%) developed symptoms during the NLT. 41 (15%) had 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 to one reading, resulted in 11% of long covid participants meeting criteria for PoTS, but not in healthy volunteers.

Conclusions
More than half of long covid patients experienced OI symptoms during NLT and more than one in ten patients met the criteria for either PoTS or OH, half of whom did not report previous typical OI symptoms. We recommend all patients attending long covid clinics are offered an NLT and appropriate management commenced.


Link | PDF (Preprint: MedRxiv)
 
Merged thread

Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study, 2024, Cassie Lee, Darren

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.

https://onlinelibrary.wiley.com/doi/10.1002/jmv.29486

 
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Mij said:
We therefore recommend all patients attending long covid clinics are offered an NLT and appropriate management commenced.
Click to expand...
Well, you first have to figure that out, having refused for decades to even try, or even acknowledge that this is a thing that happens to people after infections, even mild ones, and that it's not 'biopsychosocial', or whatever.

If you want the result of effort you have to put in the effort. And ironic that this "management" will mostly take exactly this form: if you're not getting better, you're not trying, you have to put more effort.

There's way too much wishful medicine out there. It's so weird.
 
Compare this to the NIH study. In controls, the NIH that found 3/17 (17.6%) had OH and 7/17 (41%) had symptoms. The methodology might have been different, but that is a huge difference from the 10% of controls that had asymptomatic OH and 0% that had symptoms in this study. How did the NIH recruit so many healthy controls that had OH? And this study managed to match controls correctly, but the NIH can not?
 
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