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

Abstract

AbstractBackground 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.