Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID-19 infection - a systematic review

BACKGROUND: Cardiovascular autonomic dysfunction may reportedly occur after a coronavirus-disease-2019 (COVID-19) infection, but the available evidence is scattered. Here we sought to understand the acute and mid-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiovascular autonomic function.

METHODS: We performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS-CoV-2 infection, post-COVID-19 condition. The clinical-demographic characteristics of people in the acute versus post-COVID-19 phase were compared.

RESULTS: We screened 6470 titles and abstracts. Fifty-four full-length articles were included in the data synthesis. One-hundred thirty-four cases were identified: 81 during the acute SARS-CoV-2 infection (24 thereof diagnosed by history), 53 in the post-COVID-19 phase. Post-COVID-19 cases were younger than those with cardiovascular autonomic disturbances in the acute SARS-CoV-2 phase (42 vs. 51-year-old, p=0.002) and were more frequently women (68% vs. 49%, p=0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p=0.008), postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in people with post-COVID-19 orthostatic complaints (p<0.001). Full recovery was more frequent in people with acute versus post-COVID-19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p=0.002).

CONCLUSIONS: There is evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID-19. More data about the prevalence of autonomic disorders associated with a SARS-CoV-2 infection are needed to quantify its impact on human health.