June 7 News Release: Cardiovascular Complications Guidance Statement

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Long COVID Cardiovascular Complications Likely to Have Lasting Negative Impact on Health, Economy, According to New Consensus Guidance Statement Released by the American Academy of Physical Medicine and Rehabilitation 

ROSEMONT, IL – June 7, 2022 – Today, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) announced new guidance for diagnosing and treating Long COVID cardiovascular complications. The statement was developed by the AAPM&R PASC Collaborative, a multidisciplinary group of physicians, clinicians and patient advocates convened by AAPM&R 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 AAPM&R’s 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.

AAPM&R’s PASC Collaborative published the consensus guidance statement as a peer-reviewed manuscript in the PM&R Journal. Its first consensus guidance on fatigue was released 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.

The American Academy of Physical Medicine and Rehabilitation is the national medical specialty organization representing more than 10,000 physicians specializing in physical medicine and rehabilitation. PM&R physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. PM&R physicians evaluate and treat injuries, illnesses and disability and are experts in designing comprehensive, patient-centered treatment plans. Physiatrists utilize cutting-edge as well as time-tested treatments to maximize function and quality of life. Since the beginning of 2021, AAPM&R has undertaken comprehensive efforts to support its call for a national plan to address PASC and the millions of Americans it affects.