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Impact of the COVID-19 pandemic on clinical autonomic practice in Europe: a survey of the European Academy of Neurology and the European Federation of Autonomic Societies |
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| Authors: | Alessandra Fanciulli,Fabian Leys,Magdalena Krbot Skorić,Diogo Reis Carneiro,Giovanna Calandra-Buonaura,Jennifer Camaradou,Giacomo Chiaro,Pietro Cortelli,Cristian Falup-Pecurariu,Roberta Granata,Pietro Guaraldi,Raimund Helbok,Max J. Hilz,Valeria Iodice,Jens Jordan,Evert C. A. Kaal,Anita Kamondi,Anne Pavy Le Traon,Isabel Rocha,Johann Sellner,Jean Michel Senard,Astrid Terkelsen,Gregor K. Wenning,Elena Moro,Thomas Berger,Roland D. Thijs,Walter Struhal,Mario Habek,the Collaborators of European Network of Neurological ANS laboratories |
| Affiliation: | 1. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria;2. Department of Neurology, University Hospital Centre, Zagreb, Croatia Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia;3. Department of Neurology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal;4. IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy;5. Patient partner of the EAN Scientific Panel for Autonomic Nervous System Disorders, London, UK;6. Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK;7. IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy;8. Department of Neurology, Faculty of Medicine, Transilvania University, Brasov, Romania;9. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria Department of Neurology, Kepler University, Linz, Austria;10. Icahn School of Medicine at Mount Sinai, New York, New York, USA;11. German Aerospace Center, Cologne, Germany Medical Faculty, University of Cologne, Cologne, Germany;12. Department of Neurology, Maasstad Ziekenhuis, Rotterdam, The Netherlands;13. Department of Neurology, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary Department of Neurology, Semmelweis University, Budapest, Hungary;14. Department of Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France;15. Cardiovascular Autonomic Function Lab, Faculty of Medicine and CCUL, University of Lisbon, Lisbon, Portugal;16. Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany;17. Institut des Maladies Métaboliques et Cardiovasculaires, INSERM U 1297, Toulouse, France;18. Department of Neurology, Aarhus University Hospital and Danish Pain Research Center, Aarhus University, Aarhus, Denmark;19. Division of Neurology, Grenoble Institut of Neuroscience, Grenoble Alpes University, CHU of Grenoble, Grenoble, France;20. Department of Neurology, Medical University of Vienna, Vienna, Austria Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria;21. Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands;22. Department of Neurology, Karl Landsteiner University of Health Sciences, University Hospital Tulln, Tulln, Austria;23. Department of Neurology, University Hospital Centre, Zagreb, Croatia Department of Neurology, School of Medicine, University of Zagreb, Zagreb, Croatia |
| Abstract: | Background and purposeThe objective was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on European clinical autonomic practice.MethodsEighty-four neurology-driven or interdisciplinary autonomic centers in 22 European countries were invited to fill in a web-based survey between September and November 2021.ResultsForty-six centers completed the survey (55%). During the first pandemic year, the number of performed tilt-table tests, autonomic outpatient and inpatient visits decreased respectively by 50%, 45% and 53%, and every third center reported major adverse events due to postponed examinations or visits. The most frequent newly diagnosed or worsened cardiovascular autonomic disorders after COVID-19 infection included postural orthostatic tachycardia syndrome, orthostatic hypotension and recurrent vasovagal syncope, deemed to be likely related to the infection by ≥50% of the responders. Forty-seven percent of the responders also reported about people with new onset of orthostatic intolerance but negative tilt-table findings, and 16% about people with psychogenic pseudosyncope after COVID-19. Most patients were treated non-pharmacologically and symptomatic recovery at follow-up was observed in ≥45% of cases. By contrast, low frequencies of newly diagnosed cardiovascular autonomic disorders following COVID-19 vaccination were reported, most frequently postural orthostatic tachycardia syndrome and recurrent vasovagal syncope, and most of the responders judged a causal association unlikely. Non-pharmacological measures were the preferred treatment choice, with 50%–100% recovery rates at follow-up.ConclusionsCardiovascular autonomic disorders may develop or worsen following a COVID-19 infection, whilst the association with COVID-19 vaccines remains controversial. Despite the severe pandemic impact on European clinical autonomic practice, a specialized diagnostic work-up was pivotal to identify non-autonomic disorders in people with post-COVID-19 orthostatic complaints. |
| Keywords: | autonomic nervous system COVID-19 infection COVID-19 vaccination orthostatic hypotension postural orthostatic tachycardia syndrome syncope telemedicine |