Dysautonomia following COVID-19 is not associated with subjective limitations or symptoms but is associated with objective functional limitations

Peter Ladlow, Oliver O'Sullivan, Andrew Houston, Robert Barker-Davies, Samantha May, Daniel Mills, Dominic Dewson, Rebecca Chamley, Jon Naylor, Joseph Mulae, Alexander N. Bennett, Edward D. Nicol, David A. Holdsworth

Research output: Contribution to journalArticlepeer-review

11 Citations (SciVal)


Background: Individuals who contract coronavirus disease 2019 (COVID-19) can suffer with persistent and debilitating symptoms long after the initial acute illness. Heart rate (HR) profiles determined during cardiopulmonary exercise testing (CPET) and delivered as part of a post-COVID recovery service may provide insight into the presence and impact of dysautonomia on functional ability. Objective: Using an active, working-age, post–COVID-19 population, the purpose of this study was to (1) determine and characterize any association between subjective symptoms and dysautonomia; and (2) identify objective exercise capacity differences between patients classified “with” and those “without” dysautonomia. Methods: Patients referred to a post–COVID-19 service underwent comprehensive clinical assessment, including self-reported symptoms, CPET, and secondary care investigations when indicated. Resting HR >75 bpm, HR increase with exercise <89 bpm, and HR recovery <25 bpm 1 minute after exercise were used to define dysautonomia. Anonymized data were analyzed and associations with symptoms, and CPET outcomes were determined. Results: Fifty-one of the 205 patients (25%) reviewed as part of this service evaluation had dysautonomia. There were no associations between symptoms or perceived functional limitation and dysautonomia (P >.05). Patients with dysautonomia demonstrated objective functional limitations with significantly reduced work rate (219 ± 37 W vs 253 ± 52 W; P <.001) and peak oxygen consumption (V̇O2: 30.6 ± 5.5 mL/kg/min vs 35.8 ± 7.6 mL/kg/min; P <.001); and a steeper (less efficient) V̇E/V̇CO2 slope (29.9 ± 4.9 vs 27.7 ± 4.7; P = .005). Conclusion: Dysautonomia is associated with objective functional limitations but is not associated with subjective symptoms or limitation.

Original languageEnglish
Pages (from-to)613-620
Number of pages8
JournalHeart Rhythm
Issue number4
Early online date9 Dec 2021
Publication statusPublished - 30 Apr 2022


  • Cardiopulmonary exercise testing
  • COVID-19
  • Dysautonomia
  • Exercise testing
  • Symptoms

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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