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Continuous non-invasive monitoring to detect autonomic dysfunction in long COVID

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CNSystems’ non-invasive technology significantly contributes to a well-founded cardiovascular diagnosis of COVID-19 survivors and enables a quick check of treatment efficacy.

Over the past months, the management focus of the COVID-19 pandemic is shifting from initial infections towards management of longer term illness in survivors. Recent studies have revealed that in long COVID, patients suffer from autonomic dysfunction with persistent symptoms such as breathlessness, chest pain, palpitations and orthostatic intolerance long after post-acute infections. As experts estimate a rapid increase in primary and secondary care consultations in the coming months, it is of great importance to offer easy diagnostic procedures and supporting management to patients.

Diagnosing long COVID

A recent study published by the Mayo Clinic reported autonomic dysfunction in up to 63% of patients presenting with specific symptoms, after having survived a corona infection, between March 2020 and January 2021. Diagnosis was revealed  by recording and evaluating beat-to-beat blood pressure and heart rate during head-up tilt tests.1

Autonomic function testing in long COVID patients

In another publication, experts from the Imperial College / London UK also confirm that active standing tests and tilt testing, with the help of continuous blood pressure and heart rate measurement, are essential tools for diagnosing autonomic dysfunction in long COVID patients2, which is essential for appropriate treatment and recovery.

Basic research studies investigating the complex mechanisms of a COVID-19 infection also count on the continuous, non-invasive monitoring of blood pressure and hemodynamics, such as provided by the CNAP technology, in order to apply a multidisciplinary analysis  of the cardiovascular status of the COVID-19 patient.3

However, although easy diagnosis and therapy control tools are available on the market, the current infrastructure is insufficient to cope with the existing long COVID patient population. More physicians familiar with the care of postural orthostatic tachycardia syndrome (POTS) and related autonomic diseases are definitely needed. As long as the waiting lists in tertiary care clinics with this expertise can be 6–12 months or longer, appropriate and timely diagnosis and treatment are impossible. 4

Patients are desperate and need encouragement

Many patients who have survived the acute  COVID-19 infections suffer from ongoing symptoms which have been termed “long COVID” or “post-acute COVID syndrome” 4, resulting in various medical conditions. Studies report that 93% of these patients complain of lightheadedness.1  A combination of breathlessness, palpitation, headache, chest pain, fatigue, pain, cognitive impairment, sweating, anxiety and depression are further symptoms.4,1  Many symptoms indicate orthostatic intolerance, resulting in orthostatic hypotension, POTS or even vasovagal syncope2, caused by a dysfunction of the autonomic nervous system.

Well-known American newspapers such as the New York Times, the Wall Street Journal or the Atlantic have already addressed the suffering of the so-called “COVID long-haulers” and give them a voice. Thousands of patients and their doctors are stablishing  support groups on the Internet or on social media channels (e.g. #longcovid on Twitter) to share experiences, find quick solutions2 or simply cry for help as “they fear for their future”5.

These patients are desperate, as symptoms associated with autonomic dysfunction have a severe impact on their social life, which furthermore result in serious economic consequences. A recent study reports that six to eight months after having recovered from COVID-19, patients still suffer from residual autonomic symptoms. 60% are unable to return to work, only 15% have completely recovered. 6

Quick help and efficient therapy

These patients require appropriate diagnostic and timely therapeutic interventions to improve their symptoms and functional status, in order to enable recovery and their return to normal life. Efficient approaches, such as the tilt table test or simple 10-minute active standing tests, can help to quickly diagnose autonomic dysfunction in long COVID patients.6

Summarizing all facts, we can conclude that Autonomic Dysfunction is the trigger for many symptoms that can still be present months after a COVID-19 infection has been overcome. This severely affects the quality of life of thousands of “COVID-19 veterans”. Simple autonomic function tests, such as the ACTIVE STANDING TEST, enable quick diagnosis and are essential for effective treatment . Established and easy-to-use tests and medical devices such as the Task Force® Touch platform by CNSystems for cardiovascular and autonomic assessment help to support requirements.

Make your contribution – let’s integrate autonomic testing into the treatment of the COVID long-haulers, as the American Autonomic Society makes it very clear:

It will not be possible to address the needs of this population without a commitment not just from providers, but also hospitals and medical center administration.” 4



  1. Shouman, K. et al. Autonomic dysfunction following COVID-19 infection: an early experience. Clin. Auton. Res. 2021 Apr 16:1–10. doi: 10.1007/s10286-021-00803-8.
  2. Dani, M. et al. Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies. Clin. Med. J. R. Coll. Physicians London 21, E63–E67 (2021).
  3. Bajić, D., Đajić, V. & Milovanović, B. Entropy Analysis of COVID-19 Cardiovascular Signals. Entropy (Basel). 23, (2021).
  4. Raj, S. R. et al. Long-COVID postural tachycardia syndrome: an American Autonomic Society statement. Clin. Auton. Res. 1–4 (2021) doi:10.1007/s10286-021-00798-2.
  6. Blitshteyn, S. & Whitelaw, S. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients. Immunol. Res. (2021) doi:10.1007/s12026-021-09185-5.

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