Postural tachycardia syndrome is associated with significant symptoms and functional impairment predominantly affecting young women: a UK perspective

Abstract

Objective: To examine a large UK cohort of patients with postural tachycardia syndrome (PoTS), to compare demographic characteristics, symptoms and treatment of PoTS at one centre compared to the largest patient group PoTS UK and to verify if their functional limitation is similar to patients with chronic fatigue syndrome (CFS).

Design: A cross-sectional study assessed the frequency of symptoms and their associated variables.

Patients and setting: Two PoTS cohorts were: (1) recruited via PoTS UK, (2) diagnosed at Newcastle Hospitals National Health Service (NHS) Foundation Trust 2009-2012. Patients with PoTS were then compared to a matched cohort with CFS.

Main outcome measures: Patients' detailed demographics, time to diagnosis, education, disability, medications, comorbidity and precipitants. Symptom assessment tools captured, Fatigue Impact Scale, Epworth Sleepiness Scale, Orthostatic Grading Scale (OGS), Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, Cognitive Failures Questionnaire.

Results: 136 patients with PoTS participated (84 members of PoTS UK (170 cohort; 50% return) and 52 (87 cohort; 60%) from Newcastle Clinics). The PoTS UK population was significantly younger than the clinic patients, with significantly fewer men (p=0.005). Over 60% had a university or postgraduate degree. Significantly more of the PoTS UK cohort were working, with hours worked being significantly higher (p=0.001). Time to diagnosis was significantly longer in the PoTS UK cohort (p=0.04). Symptom severity was comparable between cohorts. The PoTS total group was compared with a matched CFS cohort; despite comparable levels of fatigue and sleepiness, autonomic symptom burden (OGS) was statistically significantly higher. The most common treatment regime included β-blockers. Overall, 21 treatment combinations were described. Up to 1/3 were taking no treatment.

Conclusions: Patients with PoTS are predominantly women, young, well educated and have significant and debilitating symptoms that impact significantly on quality of life. Despite this, there is no consistent treatment.

Keywords: Clinical Physiology; General Medicine (see Internal Medicine).

Figure 1

Symptom assessment tools in the total postural tachycardia syndrome (PoTS) group compared with the age-matched and sex-matched chronic fatigue syndrome (CFS) group. Autonomic symptom burden and scores from Hospital Anxiety and Depression Scale are higher in the PoTS group compared with the CFS group while fatigue and daytime sleepiness are comparable.

Figure 2

Orthostatic Grading Scale scores in the postural tachycardia syndrome (PoTS) group with comorbid chronic fatigue syndrome (CFS; PoTS +) and PoTS without comorbid CFS (PoTS −) are significantly higher compared with the group with CFS.