Clinical Presentation, Diagnostic Delays, and Treatment Outcomes in Postural Orthostatic Tachycardia Syndrome (POTS): An Observational Case Series Study in a Single-Centre District General Hospital.

Abstract

BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disorder of autonomic regulation characterised by unexplained orthostatic tachycardia in the absence of postural hypotension. POTS is a complex and challenging diagnosis owing to the non-specific nature of the presentations, which frequently overlap with other medical conditions. There is limited availability of data and research describing the spectrum of clinical presentations, diagnostic pathways, comorbidities, and management outcomes. This study aims to describe the above in a single-centre district general hospital setting. METHODS: We conducted a retrospective case series study of 37 patients diagnosed with POTS at Queen's Hospital Burton (QHB) between August 2023 and August 2024. We used electronic health records to acquire relevant data. This included demographics, presenting complaints, associated conditions, time to diagnosis, specialist involvement, management strategies, and treatment outcomes. 'Time to diagnosis' was defined as the period between the first symptom onset and obtaining a confirmed diagnosis with a positive tilt-table test. Microsoft Excel (Redmond, USA) was utilised for descriptive statistical analysis. RESULTS AND CONCLUSION: The cohort was predominantly female (n = 36, 97%) with a mean age of 28.2 years (SD, 8.3; range, 18-48). The most common presenting complaints were presyncope (49%) and presyncope with syncope (41%). These were often associated with palpitations and chest discomfort. Systemic conditions coexisting with POTS included anxiety/depression, hypermobility spectrum disorders (notably Ehlers-Danlos Syndrome), fibromyalgia, autoimmune diseases, and migraine. The median time to diagnosis was one year (IQR 1-4). However, delays of up to 20 years were observed. Speciality referrals involved cardiology (65%), neurology (13%), and internal medicine (10%). Management strategies included non-pharmacological therapy alone (19%), additionally pharmacological monotherapy (62%), and combination therapy with multiple drugs (19%). Symptomatic improvement was reported in 65% overall, with the highest rates observed in the multi-drug therapy group. This study highlights the demographic profile, burden of comorbidities, and diagnostic challenges in patients with POTS. Our single-centre study has demonstrated meaningful progress towards reducing the average time to diagnose POTS with varying treatment outcomes across therapeutic strategies. Multi-drug therapy in conjunction with non-pharmacological therapy proved to be the most efficacious in this cohort. These findings emphasise the importance of early recognition, streamlined referral pathways, and the need for further large-scale multi-centre research into patient-tailored, evidence-based management of POTS.