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

Fanciulli A, Leys F, Krbot Skorić M, Reis Carneiro D, Calandra-Buonaura G, Camaradou J, Chiaro G, Cortelli P, Falup-Pecurariu C, Granata R, Guaraldi P, Helbok R, Hilz MJ, Iodice V, Jordan J, Kaal EC, Kamondi A, Pavy Le Traon A, Rocha I, Sellner J, Senard JM, Terkelsen A, Wenning GK, Moro E, Berger T, Thijs RD, Struhal W, Habek M, Adamec I, Aerts A, Campese N, Canta LL, Delamont RS, de Lange F, Del Sorbo F, Devigili G, Di Leo R, Dinh T, Fortrat JO, Gierthmühlen J, Hemels M, Köhn J, Krøigård T, Lipp A, Maier A, Marinelli L, Mazzeo A, Milenkovic I, Motyl M, Sora MGN, Navarro-Otano J, Nilsen KB, Oliveira M, Omland PM, Pelliccioni G, Pereon Y, Resch RJ, Rocchi C, Roche F, Rutten J, Tijero-Merino B, Tutaj M, van der Heijden-Montfroy AM, van Hoeve BJ, van Orshoven N, Wang R, Graggen WJ (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 30

Pages Range: 1712-1726

Journal Issue: 6

DOI: 10.1111/ene.15787

Abstract

Background and purpose: The objective was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on European clinical autonomic practice. Methods: Eighty-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. Results: Forty-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. Conclusions: Cardiovascular 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.

Involved external institutions

L’Istituto delle Scienze Neurologiche di Bologna (ISNB) Italy (IT) Transilvania University of Brasov / Universitatea Transilvania din Brașov Romania (RO) Medizinische Universität Innsbruck Austria (AT) Icahn School of Medicine at Mount Sinai United States (USA) (US) National Hospital For Neurology and Neurosurgery United Kingdom (GB) Deutsches Zentrum für Luft- und Raumfahrt e.V. (DLR) / German Aerospace Center Germany (DE) Maasstad Ziekenhuis Netherlands (NL) National Institute of Mental Health Information Resource Center United States (USA) (US) Centre Hospitalier Universitaire (CHU) de Toulouse France (FR) University of Lisbon / Universidade de Lisboa (ULisboa) Portugal (PT) Landesklinikum Mistelbach-Gänserndorf Austria (AT) Institute of Cardiovascular and Metabolic Diseases / Institut des Maladies Métaboliques et Cardiovasculaires (I2MC) France (FR) Aarhus University Hospital / Aarhus Universitetshospital Denmark (DK) Zagreb University Hospital Centre / Klinički bolnički centar Zagreb (KBC) Croatia (HR) Universidade de Coimbra Portugal (PT) European Academy of Neurology (EAN) Austria (AT) Leiden University Medical Center Netherlands (NL) Karl Landsteiner Privatuniversität für Gesundheitswissenschaften GmbH Austria (AT) Grenoble Institute of Neurosciences (GIN) / Institut des Neurosciences de Grenoble France (FR) Medizinische Universität Wien Austria (AT)

How to cite

APA:

Fanciulli, A., Leys, F., Krbot Skorić, M., Reis Carneiro, D., Calandra-Buonaura, G., Camaradou, J.,... Graggen, W.J. (2023). 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. European Journal of Neurology, 30(6), 1712-1726. https://dx.doi.org/10.1111/ene.15787

MLA:

Fanciulli, Alessandra, et al. "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." European Journal of Neurology 30.6 (2023): 1712-1726.

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