Key result
Orthostatic symptom burden is higher in POTS than other long-term conditions, with preliminary evidence suggesting compression garments and certain medications may reduce symptom burden.
Why the study?
Postural orthostatic tachycardia syndrome is poorly understood with no approved licensed treatments, prompting a review to contextualize symptom burden and identify associated factors to guide future therapies.
Do interventions such as compression garments, propranolol, pyridostigmine, desmopressin, and bisoprolol reduce symptom burden in adults with POTS?
Systematic Review (n=2,314)
Do interventions such as compression garments, propranolol, pyridostigmine, desmopressin, and bisoprolol reduce symptom burden in adults with POTS?
POTS is associated with a high symptom burden compared to other long-term conditions, and while several pharmacological and non-pharmacological interventions show preliminary promise, standardized outcome measures and effectiveness trials are needed.
High POTS symptom burden, especially orthostatic intolerance versus other conditions, warrants targeted management; leaves open factors to guide future therapies.
BACKGROUND AND OBJECTIVE: Postural Orthostatic Tachycardia Syndrome (POTS) is a chronic health condition affecting mostly women of childbearing age, and significantly impacting their health and quality of life. It is currently poorly understood with no approved licensed treatments. The aim of this systematic review was to contextualize the symptom burden of POTS, and review factors associated with this burden that may guide future treatments. The specific questions were (1) How does symptom burden in POTS compare to the burden in other long term conditions (LTCs), (2) Which factors are associated with POTS symptom burden, and (3) Which interventions show promise in reducing symptom burden in POTS. DATABASES AND DATA TREATMENT: Electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, APA PsycArticles, OpenGrey) were searched from inception to January 2022 for observational studies reporting on the association between any biological, psychological or social factors and symptom burden, and randomized controlled trials reporting on interventions for symptom burden in adults with POTS. Two reviewers independently conducted eligibility screening, data extraction and quality assessment. A narrative synthesis was undertaken. RESULTS/CONCLUSION: 5159 entries were screened for eligibility. Twenty-nine studies were included (1372 participants with POTS of a total sample size of 2314, 17 High-, 12 Medium-quality), seventeen were observational and twelve were randomized controlled experimental and intervention trials. Overall methodological quality of the evidence was medium-high but heterogeneity was high and sample sizes modest, allowing moderately robust conclusions. Orthostatic symptom burden was higher in POTS than other LTCs. Serum activity against adrenergic α1 receptors, physical functioning, depression, catastrophizing, prolonged cognitive stress testing and anxiety were significantly associated with symptom burden in medium-high quality studies. Preliminary medium-high quality evidence from predominantly proof-of-concept (n = 11) studies and one 3-month 2 × 2 factorial design trial suggest that compression garments, propranolol, pyridostigmine, desmopressin, and bisoprolol may hold promise in reducing symptom burden. Directions for future research include investigating associated factors over time, the development of complex interventions which address both biological and psychosocial factors associated with symptom burden, and effectiveness trials of these interventions. SIGNIFICANCE: POTS symptom burden is high, particularly in relation to orthostatic intolerance when compared to other long-term conditions (LTCs). Despite this burden, there are no effectiveness randomized controlled trials of treatment to reduce symptoms in POTS. This review provides a starting point to understanding researched biological and psychosocial factors associated with this burden. There was however inconsistency in the measurement of symptom burden, lowering the confidence of cross-study inferences. A coherent definition of POTS symptom range, severity and impact along with a validated and reliable POTS-specific instrument is currently lacking. A standardized questionnaire to assess POTS symptom burden as a core outcome measure will help clarify future research and clinical practice.
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Knoop et al. (2022) conducted a systematic review in Postural Orthostatic Tachycardia Syndrome (POTS) (n=2,314). Various interventions (compression garments, propranolol, pyridostigmine, desmopressin, bisoprolol) and associated factors vs. Other long-term conditions or control groups was evaluated on Symptom burden. Orthostatic symptom burden is higher in POTS than other long-term conditions, with preliminary evidence suggesting compression garments and certain medications may reduce symptom burden.
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