Summary: Researchers report that postural orthostatic tachycardia syndrome (POTS) appears in nearly one-third of patients with severe long COVID, a far higher rate than in the pre-pandemic general population. The largest study to date on this topic found that primarily middle-aged women were affected and commonly experienced dizziness, rapid heart rate, fatigue, and impaired concentration. These results emphasize the need to screen long COVID patients for POTS to improve diagnosis, management, and recovery.
Although POTS can significantly reduce quality of life, it can be identified using simple, low-cost tests and managed with established therapies that reduce symptoms and support recovery. Early recognition in long COVID patients offers an opportunity to improve daily functioning and wellbeing.
Key Facts:
- High prevalence: 31% of patients with severe long COVID in the study were diagnosed with POTS.
- Demographic impact: 91% of those diagnosed were middle-aged women who were generally healthy before developing long COVID.
- Detectable and treatable: POTS can be detected with inexpensive tests available in many care settings and treated to alleviate symptoms.
Source: Karolinska Institute
What is POTS? Postural orthostatic tachycardia syndrome is a disorder in which the heart rate rises excessively when a person moves from lying down to standing up. This abrupt heart-rate increase often causes dizziness and an intense need to sit or lie down, a condition known as orthostatic intolerance. People with POTS may also have an elevated resting heart rate and pronounced heart-rate responses to physical activity. Common accompanying complaints are fatigue and trouble concentrating—symptoms frequently reported by long COVID patients.
Researchers at Karolinska Institutet evaluated a large group of patients with severe long COVID and found that POTS was present in nearly one in three. By comparison, before the pandemic fewer than one percent of the Swedish population had been diagnosed with POTS.
“Smaller studies previously suggested a connection between long COVID and POTS, but this larger and more detailed investigation confirms that POTS is a common condition in patients with severe long COVID. This knowledge is important for clinicians and for patients seeking explanations and care,” says Mikael Björnson, doctoral student at the Department of Medicine, Solna, Karolinska Institutet.
Predominantly women in early middle age
This is the largest, most detailed study so far examining POTS in long COVID. The research team prospectively assessed 467 non-hospitalized patients experiencing severe long COVID symptoms (defined as sick leave of 50% or more). Most participants—91%—were middle-aged women who had been generally healthy and physically active before their illness.
Participants were evaluated at a median of twelve months after their initial COVID-19 infection. They completed standardized health questionnaires and underwent physical testing. Those with signs suggestive of POTS received further cardiology assessment, including targeted testing, to confirm a diagnosis.
Overall, 31% of the participants met diagnostic criteria for POTS, 27% had symptoms consistent with POTS but did not meet full diagnostic criteria, and 42% showed no clinical signs of POTS. Patients diagnosed with POTS demonstrated significantly higher heart rates during walking tests and reported lower health-related quality of life compared with other long COVID patients.
Detection and treatment
“Importantly, POTS can be identified using inexpensive and straightforward tests that are widely available across healthcare settings,” says Judith Bruchfeld, associate professor at Karolinska Institutet, senior consultant in infectious diseases at Karolinska University Hospital, and lead author of the study. “For patients who receive a POTS diagnosis, there are management strategies that can meaningfully reduce symptoms and improve daily life.”
The research team recommends that clinicians evaluate long COVID patients who report a pronounced increase in heart rate when standing from a lying position or during exertion, particularly when symptoms include dizziness, cognitive impairment (“brain fog”), and severe fatigue. Systematic assessment for POTS in these patients can lead to targeted interventions and better symptom control.
The investigators plan to follow this cohort for four to five years, and to include hospitalized COVID-19 patients in future analyses. These follow-up studies will examine long-term recovery, functional capacity, and how POTS-related symptoms evolve over time.
Funding: The study was conducted in collaboration with Karolinska University Hospital and funded by the Swedish Research Council and the Swedish Heart-Lung Foundation.
Key Questions Answered:
A: Postural orthostatic tachycardia syndrome is a condition in which the heart rate rises abnormally when moving from lying down to standing, often causing dizziness, fatigue, and cognitive difficulties.
A: In this study of highly symptomatic, non-hospitalized long COVID patients, nearly one-third were diagnosed with POTS, compared with under 1% prevalence in the Swedish population before the pandemic.
A: Yes. POTS can be diagnosed with simple tests and managed with therapies and lifestyle measures that reduce symptoms and improve quality of life.
About this POTS and long COVID research
Author: Press Office
Source: Karolinska Institute
Contact: Press Office – Karolinska Institute
Image: The image is credited to Neuroscience News
Original Research: Open access. “Prevalence and Clinical Impact of Postural Orthostatic Tachycardia Syndrome in Highly Symptomatic Long COVID” by Mikael Björnson et al., Circulation: Arrhythmia and Electrophysiology. DOI: 10.1161/CIRCEP.124.013629
Abstract
Prevalence and Clinical Impact of Postural Orthostatic Tachycardia Syndrome in Highly Symptomatic Long COVID
BACKGROUND:
Concerns about the incidence of postural orthostatic tachycardia syndrome (POTS) following COVID-19 have grown since early case reports in 2021. This study aimed to determine the prevalence and clinical impact of POTS in a well-characterized series of patients with long COVID.
METHODS:
We prospectively evaluated 467 non-hospitalized, highly symptomatic long COVID patients (sick leave ≥50%) and compared demographics and clinical assessment outcomes between those diagnosed with POTS and other long COVID patients. Examinations occurred at a median of 12 months after acute infection. Patients with suspected POTS underwent cardiology evaluation including 48-hour ECG, head-up tilt testing, and an Active Stand Test.
RESULTS:
Among the cohort, 143 patients (31%) were diagnosed with POTS, 128 (27%) had symptoms consistent with POTS but did not meet full diagnostic criteria, and 196 (42%) showed no clinical signs of POTS. Patients with POTS were younger (mean age 40.0 years) than the other groups (mean ages 44.0 and 47.0 years; P ≤ 0.001) and were predominantly female (91%).
Those with POTS reported lower levels of physical activity on the Frändin-Grimby scale (P = 0.001). Heart rates during a 6-minute walk test were higher in the POTS group both during walking and at rest afterward; they also walked a shorter distance (448 m vs. 472 m vs. 509 m, respectively; P ≤ 0.001). Symptom distribution across groups showed substantial overlap.
CONCLUSIONS:
In this cohort of predominantly younger women with severe long COVID, POTS is common and presents with symptoms that overlap with non-POTS long COVID patients. Long COVID patients with POTS have reduced physical activity and lower exercise capacity compared with non-POTS long COVID patients, and systematic assessment for POTS is warranted in this population.