AAPM&R Long COVID Cardiovascular Complications Guidance Statement Released

Members & Publications


June 7, 2022

We’re excited to announce the release of new guidance for diagnosing and treating Long COVID cardiovascular complications. The statement was developed by our PASC Collaborative, a multidisciplinary group of physicians, clinicians and patient advocates convened to address the pressing need for guidance in caring for patients with Long COVID.

Post-Acute Sequelae of SARS-CoV-2 infection (PASC) or Long COVID is a condition that occurs in individuals who have had COVID-19 and report at least one persistent symptom after acute illness. Long COVID encompasses a constellation of varied and ongoing symptoms – even in the same patient across time – and may include neurological challenges, cognitive symptoms such as brain fog, cardiovascular and respiratory issues, fatigue, pain and mobility issues, among others. An estimated eight to twenty-five million Americans have or have had symptoms of Long COVID, based on extrapolated data from the Journal of the American Medical Association and our Long COVID Dashboard. Cardiovascular complications are common and can be a serious Long COVID symptom.

In addition to providing clinicians with diagnosis and treatment guidance, the PASC Collaborative statement warns that cardiovascular diseases stemming from Long COVID may reduce life expectancy and economic productivity and urges governments and health systems worldwide to prepare.

“Unfortunately, many people could have chronic cardiovascular conditions due to COVID-19 infection–even patients without previous cardiovascular disease, comorbidities and otherwise low risk of cardiovascular disease,” said Jonathan H. Whiteson, MD, FAAPMR, lead author of the cardiovascular complications guidance statement. “Because of the chronic nature of cardiovascular conditions, there will likely be long-lasting consequences for patients and health systems worldwide.”

Long COVID cardiovascular symptoms and complications range from mild to incapacitating. Individuals with pre-existing heart disease and risk factors for heart disease are at increased risk of severe COVID-19 illness and death, including from further cardiovascular system involvement. Incidence of pulmonary embolism, arterial and venous thromboses, myocardial infarction and stroke are all elevated in post-acute COVID.

“There are already equity challenges in access, diagnosis and treatment for certain patients with cardiovascular diseases,” said Alba Azola, MD, author of the cardiovascular complications guidance statement. “Individuals from racial and ethnic minority groups already have lower referral rates to cardiac rehabilitation than people classified as White/Caucasian. Women also may be underdiagnosed and undertreated for cardiac conditions.”

Rehabilitation for patients with Long COVID symptoms should be individually tailored and move at the patient’s own pace rather than a set timetable. Medical professionals should be cautious when recommending activity and exercise to avoid post-exertional symptom exacerbation using an individualized approach.

Our PASC Collaborative released its first consensus guidance on fatigue in August 2021, followed by guidance on breathing discomfort and  cognitive symptoms in December. Additional consensus guidance statements on Long COVID in pediatric patients, autonomic disorders, mental health and neurology will be published on a rolling basis.

Please join us in sharing this guidance with your colleagues to support patients. Learn more about our Call to Action (and our successes!) and our Long COVID Dashboard.


Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.