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Although many people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) recover completely, others are left with long-lasting symptoms that persist for at least 4 weeks, a condition referred to by the National Institutes of Health (NIH) as post-acute sequelae of SARS-CoV-2 infection (PASC).1 The Centers for Disease Control and Prevention (CDC) defines post-COVID (coronavirus disease) conditions as the wide range of health consequences that are present for four or more weeks after infection with SARS-CoV-2,2 whereas the World Health Organization (WHO) refers to post-COVID condition as symptoms that persist beyond 12 weeks after an initial infection, last for at least 2 months, and cannot be explained by an alternative diagnosis.3 There are a number of terms found in the literature that describe this condition (e.g., long COVID, persisting symptoms post-COVID, post-acute COVID-19, long-haul COVID, and others), but for the purposes of this statement, the term PASC is used. PASC can present with a non-specific constellation of signs and symptoms,4 some of which appear to be autonomic in nature. These include, but are not limited to, orthostatic intolerance, palpitations, tachycardia, syncope, orthostatic hypertension, labile blood pressures, dizziness, fatigue, and exercise intolerance.5 The most common autonomic diagnoses associated with PASC are orthostatic intolerance and postural orthostatic tachycardia syndrome (POTS), which often follow a viral infection.5 Other common features of PASC that may be related to autonomic dysfunction include cognitive impairment (often called “brain fog”), headache, insomnia, neuropathic pain, gastrointestinal and genitourinary dysfunction, and allergic symptoms suggestive of mast cell activation, such as pruritis, urticaria, flushing, angioedema, wheezing, food sensitivities, and others.6 Although the mechanisms of post-COVID autonomic dysfunction and PASC in general are being investigated, several possible etiologies have been proposed including autoimmunity, inflammation, persistent T-cell abnormalities, endothelial dysfunction, prothrombotic state, mast cell activation, small fiber neuropathy, and others.5, 7-12 Data released by the CDC demonstrate that one in five adults (19%) who had COVID in the past still has symptoms of “long COVID,” and overall, 1 in 13 adults in the United States (7.5%) has “long COVID” symptoms.13 Estimates in the United Kingdom (UK) suggest that ~3% of the UK population is experiencing persistent symptoms 4 weeks after acute infection.14 Despite the prevalence of prolonged symptoms and emerging data on various manifestations and possible mechanisms, limited guidance exists regarding the assessment and treatment of the broad constellation of symptoms, including autonomic dysfunction, due to PASC. With this in mind, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Multi-Disciplinary PASC Collaborative (PASC Collaborative) was convened to address the urgent need for interim guidance in the care of patients with PASC. This document is part of a larger series addressing the most common manifestations of PASC, and specifically discusses the assessment and treatment of autonomic dysfunction. Fatigue, cognitive symptoms, respiratory sequalae, and cardiovascular complications of PASC are discussed elsewhere.15-18 The PASC Collaborative was created, in part, to develop expert recommendations and guidance from established PASC centers with extensive experience in managing patients with PASC. The Collaborative is composed of 41 established post-COVID-19 or PASC centers, the first of which were established in April to June of 2020. The PASC Collaborative is following an iterative modified Delphi approach to achieve consensus on assessment and treatment recommendations for a series of consensus guidance statements focused on the most prominent PASC symptoms.15-18 The full description of this process has been published in detail previously.19 At present, scientific evidence regarding effective assessment and treatment of PASC is limited, which prevents the creation of evidence-based clinical guidelines. These statements were developed by a diverse team of experts, with patient input, and integrate current experience and expertise with available evidence to provide tools to clinicians treating patients. There is an intentional focus on health equity as disparities in care and outcomes are critically important to address. Beyond offering recommendations for assessment and treatment based on experience with care of patients presenting with PASC symptoms, the hope is that a broadened understanding of current patient care practices will help identify areas of future research. We acknowledge that the definition of PASC is evolving and that there are various factors that contribute to a diagnosis. In addition, PASC is broad and likely encompasses several different subtypes, some of which have overlapping clinical features. As such, the guidance statements developed by the PASC Collaborative are intended for broad audiences that could span primary care clinicians, physical medicine and rehabilitation physicians, and other specialists. This guidance statement is intended to reflect current practice in patient assessment, testing, and treatment, acknowledging the paucity of data on the diagnosis and treatment of PASC. In addition, we recognize the shortage of autonomic specialists in the United States, which limit access to specialized autonomic evaluation and testing for many patients. At the time of development of this guidance statement, the early literature focused on patients who were not vaccinated, and the incidence and trajectory of PASC in vaccinated patients with “breakthrough” cases (including current and emerging variants of the virus) is evolving. The PASC Collaborative considered these issues during the development process, and these guidance statements generally apply to individuals who develop PASC regardless of their vaccination status. It is important to note that the recommendations provided in this guidance statement should not preclude clinical judgment and must be applied in the context of the specific patient, with adjustments for patient preferences, comorbidities, and other factors. As with any treatment plan, clinicians treating individuals with PASC are encouraged to discuss the unknowns and ambiguities of PASC diagnosis, treatment and prognosis, as well as the benefits and risks of any interventions. In addition, the PASC Collaborative recognizes that patients with autonomic dysfunction due to PASC typically present with a cluster of symptoms and signs that span multiple body systems and may overlap with cardiovascular and pulmonary complications that are not necessarily due to autonomic dysfunction. These issues and suggested treatments are covered in separate PASC Collaborative guidance statements.15-18 In this consensus statement, we use the term “autonomic dysfunction” to refer to any disturbance of the autonomic nervous system, including autonomic symptoms and common autonomic disorders, such as postural orthostatic tachycardia syndrome (POTS), neurocardiogenic syncope (NCS) which is also known as vasovagal syncope, orthostatic hypotension (OH), and inappropriate sinus tachycardia (IST). Orthostatic intolerance (OI) is used when objective tests do not confirm a diagnosis of one of the common autonomic in a clinical of autonomic symptoms that are by an and by The of and are in on PASC Collaborative and patient during the consensus process, we at assessment and treatment guidance statements that may be by health care when a patient with autonomic dysfunction. We health care to this guidance early diagnosis, and of autonomic dysfunction may impairment and in patients with PASC. 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