Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation: Arrhythmia and Electrophysiology https://doi.org/10.1161/CIRCEP.124.013629 Dr. Mikael Björnson et al.
Points
- The study assessed POTS prevalence and impact in 467 highly symptomatic, non-hospitalized long COVID patients.
- Of the cohort, 31% (143 patients) were diagnosed with POTS, primarily younger women (91%, mean age 40.0 years).
- POTS patients had significantly lower physical activity (P=0.001) compared to non-POTS long COVID groups.
- They also showed higher heart rates and significantly shorter 6-minute walk distances (448 m, P≤0.001).
- POTS is common in this long COVID cohort, conferring lower physical capacity, and warrants systematic assessment.
Summary
This prospective study aimed to assess the prevalence and clinical impact of Postural Orthostatic Tachycardia Syndrome (POTS) in a cohort of 467 non-hospitalized, highly symptomatic long COVID patients (defined by sick leave ≥50%). With initial reports of POTS in long COVID emerging in 2021, this research sought to characterize its occurrence and consequences. Examinations, including cardiologist evaluations with 48-hour ECG, head-up tilt tests, and Active Stand Tests for clinically suspected cases, were conducted at a median of 12 months post-acute COVID-19 infection.
The findings revealed a significant prevalence of POTS within this long COVID cohort: 143 patients (31%) were diagnosed with POTS, 128 (27%) did not meet POTS criteria but showed some signs, and 196 (42%) had no clinical signs of POTS. Patients diagnosed with POTS were notably younger, with a mean age of 40.0 years, compared to 44.0 and 47.0 years in the other two groups, respectively (P≤0.001). This group was also predominantly female, comprising 91% of POTS diagnoses. A key clinical impact observed was significantly lower physical activity in POTS patients, as measured by the Frändin-Grimby scale (P=0.001), compared to non-POTS groups.
Furthermore, the study demonstrated that POTS patients exhibited significantly higher heart rates both during and after the 6-minute walk test, alongside a significantly shorter walking distance (448 m for POTS vs. 472 m and 509 m for the other groups, respectively; P≤0.001). Despite these distinct physiological and functional differences, the distribution of reported symptoms showed no significant variation across the groups, indicating symptom overlap between POTS and non-POTS long COVID patients. The conclusions highlight that POTS is common in this cohort, particularly among younger women, and is associated with reduced physical activity and capacity, warranting systematic assessment in long COVID.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013629
References
Björnson, M., Wijnbladh, K., Törnberg, A., Svensson-Raskh, A., Svensson, A., Ståhlberg, M., Runold, M., Fedorowski, A., Nygren Bonnier, M., & Bruchfeld, J. (2025). Prevalence and clinical impact of postural orthostatic tachycardia syndrome in highly symptomatic long covid. Circulation: Arrhythmia and Electrophysiology, e013629. https://doi.org/10.1161/CIRCEP.124.013629
