Postural orthostatic tachycardia syndrome post-COVID vaccination less likely vs. infection
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The odds for developing new postural orthostatic tachycardia syndrome within 90 days after COVID-19 vaccination were more than five times lower compared with likelihood after SARS-CoV-2 infection, researchers reported.
Although the probable incidence of new postural orthostatic tachycardia syndrome (POTS) after COVID-19 vaccination remained low, odds were higher compared with referent conventional primary care diagnoses but lower compared with the odds after SARS-CoV-2 infection, according to a study published in Nature Cardiovascular Research.
“The main message here is that while we see a potential link between COVID-19 vaccination and POTS, preventing COVID-19 through vaccination is still the best way to reduce your risk of developing POTS,” Alan C. Kwan, MD, cardiovascular specialist at the Smidt Heart Institute at Cedars-Sinai, said in a press release.
“From this analysis, we found that the odds of developing POTS are higher 90 days after vaccine exposure than the 90 days prior to exposure,” Kwan said in the release. “We also found that the relative odds of POTS were higher than would be explained by increases in visits to physicians after vaccination or infection.”
To better understand the risk for POTS in the 90 days after COVID-19 vaccination compared with a 90-day control period before vaccine exposure, Kwan and colleagues used a sequence-symmetry analysis to evaluate the electronic health record data of 284,592 vaccinated patients (mean age, 52 years; 57% women; 63% white).
New POTS-related diagnosis odds were compared with odds of myocarditis and common primary care diagnoses as benchmarks to account for potential confounding from changes in patient engagement with the health care system during the pandemic, according to the study.
POTS following COVID-19 vaccination
Within this cohort 62% received the BNT162b2 vaccine (Pfizer-BioNTech); 31% received the mRNA-1273 vaccine (Moderna); 6.9% received the Ad26.COV2.S vaccine (Johnson & Johnson/Janssen); and less than 0.1% received other vaccines such as the ChAdOx1-S (AstraZeneca), NVX-CoV2373 (Novavax) and CoronaVac (Sinovac).
Researchers observed that the odds of a new POTS-associated diagnoses in the 90 days after vaccination (OR = 1.33; 95% CI, 1.25-1.41; P < .001) was higher compared with common primary care diagnoses (OR = 1.21; 95% CI, 1.18-1.23; P < .001) but lower when compared with myocarditis (OR = 2.57; 95% CI, 1.02-6.77; P = .046). These findings were similar following receipt of a booster vaccine and regardless of patient sex, demographic or vaccine type.
POTS following SARS-CoV-2 infection
Researchers conducted a separate analysis to evaluate the odds of POTS-related diagnosis after SARS-CoV-2 infection in 12,460 patients (mean age, 47 years; 50% women; 54% white).
Researchers observed higher odds of new POTS-associated diagnoses in the 90 days after SARS-CoV-2 infection (OR = 1.52; 1.33-1.72; P < .001) compared with common primary care diagnoses (OR = 1.4; 95% CI, 1.31-1.5; P < .001); however, the difference was not significant (OR = 1.08; 95% CI, 0.93-1.25; P = .29).
Moreover, the odds for a new diagnosis of POTS in the 90 days after SARS-CoV-2 infection was five times greater compared with vaccination (OR = 5.35; 5.05-5.68; P < .001).
“In an unexpected but important way, the COVID-19 pandemic brought a great deal of awareness to POTS — both to patients and providers,” Peng-Sheng Chen, MD, cardiac electrophysiologist at the Smidt Heart Institute at Cedars-Sinai, said in the release. “Given a broader understanding of the disease, many patients can be diagnosed more quickly permitting earlier interventions that can greatly improve their symptoms.”
Reference:
- COVID infection, and vaccination, linked to heart condition. https://www.eurekalert.org/news-releases/973538. Published Dec. 12, 2022. Accessed Dec. 12, 2022.
Perspective
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Prior to COVID-19, most physicians did not know a lot about POTS or how to treat it. That is changing, as a significant number of people developed postural intolerance with tachycardia following COVID-19 infection. In this study, the authors evaluated whether POTS was also more common following vaccination for COVID-19. They assessed medical records from the Cedars-Sinai Health System and looked for diagnoses of POTS before and after vaccination. Because there are no formal codes for POTS, the researchers had to pull together a group of diagnostic codes that might indicate POTS. Limitations withstanding, they did find an increased risk for these POTS-like diagnoses following vaccination, but it is much lower than the incidence of POTS following COVID-19 infection.
I have seen a lot of post-vaccination syndromes, including myocarditis, pericarditis, tachycardia, chest pains and fatigue, although I personally have not seen POTS following vaccination. But that is why we do these large studies. It’s important to bring attention to these syndromes so that clinicians are primed to look for them and treat accordingly.
Many people have tachycardia following COVID-19 and even following vaccination; thankfully, only some of these people have POTS, which can be a debilitating condition. Establishing a diagnosis is the first step. This can be done at the bedside by measuring BP and heart rate while lying down and then standing up for 10 minutes. A sustained increase in heart rate of 30 bpm — without a drop in BP — is what defines POTS. A comprehensive treatment approach is needed which involves hydration with electrolytes, salt loading, compression bands and most importantly, a very structured exercise regimen that starts with recumbent exercises. This is called the Levine method; it is well-studied and effective.
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