Publication date: Oct 15, 2024

Background: The longitudinal prevalence and autonomic symptom burden in Long COVID patients is not well-established. Objective: Assess the duration and severity of autonomic dysfunction in adults with Long COVID and evaluate its impact on function and quality of life. Design: A follow-up survey of a subset of participants from a cross-sectional online survey of adults with Long COVID. Multivariable logistic regression identified predictors of moderate to severe autonomic dysfunction. Participants: 526 adults (ages 20-65) with a history of Long COVID Main measures: The Composite Autonomic Symptom 31 (COMPASS-31) score, the RAND 36-Item Health Survey, the prevalence of new postural orthostatic tachycardia syndrome (POTS), and predictors of autonomic dysfunction, including POTS. Key results: 71.9% of Long COVID patients had a COMPASS-31 score >20, suggestive of moderate to severe autonomic dysfunction. The median symptom duration was 36 [30-40] months, reaching up to 3.5 years after SARS-CoV-2 infection. 37.5% of Long COVID patients could no longer work or had to drop out of school due to their Long COVID illness. 40.5% were newly diagnosed with POTS following SARS-CoV-2 infection. Conclusions: Evidence of persistent moderate to severe autonomic dysfunction was seen in 71.9% of Long COVID patients in our study, with a 36-month median symptom duration, suggesting that enduring autonomic dysfunction is highly prevalent in the Long COVID population. Moderate to severe autonomic dysfunction was significantly correlated with impaired function and capacity, highlighting the need to address POTS and other manifestations of autonomic dysfunction as a key component of Long COVID management.

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