Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection, 2022, Kwan et al

Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection
Kwan, Alan C.; Ebinger, Joseph E.; Wei, Janet; Le, Catherine N.; Oft, Jillian R.; Zabner, Rachel; Teodorescu, Debbie; Botting, Patrick G.; Navarrette, Jesse; Ouyang, David; Driver, Matthew; Claggett, Brian; Weber, Brittany N.; Chen, Peng-Sheng; Cheng, Susan

Postural orthostatic tachycardia syndrome (POTS) was previously described after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, limited data are available on the relation of POTS with Coronavirus Disease 2019 (COVID-19) vaccination.

Here we show, in a cohort of 284,592 COVID-19-vaccinated individuals, using a sequence–symmetry analysis, that the odds of POTS are higher 90 days after vaccine exposure than 90 days before exposure; we also show that the odds for POTS are higher than referent conventional primary care diagnoses but lower than the odds of new POTS diagnosis after SARS-CoV-2 infection.

Our results identify a possible association between COVID-19 vaccination and incidence of POTS. Notwithstanding the probable low incidence of POTS after COVID-19 vaccination, particularly when compared to SARS-Cov-2 post-infection odds, which were five times higher, our results suggest that further studies are needed to investigate the incidence and etiology of POTS occurring after COVID-19 vaccination.

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ETA: Speaking of energy to properly understand, I don't know how to quote just a small bit of a Member's comments. So, this my attempt to try to get that figured out.

 

News and Views commentary on this paper from Svetlana Blitshteyn and Artur Fedorowski

The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection: it’s worth a shot (Nature Cardiovascular Research, Dec 2022)

 

Note that an issue has been raised around the 5.3x odds ratio of POTS between infection-only and vaccine-only cohorts.

https://twitter.com/user/status/1605677102635708416


It's centred on the study design as summarised in their figure 3. This shows odds being calculated for the vaccination-only cohort, pre- and post- intervention: for both POTS diagnoses and Common Primary Care diagnoses. Then an odds ratio is calculated between these diagnoses, for the vaccination group.

For the infection group, odds have not been expressed in this graphic, and what is labelled as "OR 5.35" would seem to be a post-intervention incidence ratio for POTS.



Obviously this is not a randomised trial - the two groups self-selected whether they would or would not have vaccination (with infection being under neither subject or investigator control). So their background rates might well be expected to be different. The findings that pre-intervention the POTS incidence was a little under 5x are now being highlighted as very close to the 5.3x, as summarised in the abstract.

Perhaps people that chose no-vaccine had existing conditions or related reasons that associated with a higher rate of POTS development (pre- and post- infection). I note that the infection-only group had zero new EDS diagnoses, pre- or post- (vs 6.68 & 7.73 /100K for the vaccinated group). Does this mean that they already had EDS, so couldn't be newly diagnosed within the 90 days pre-intervention?

 

Is it?
I had never heard of Nature Cardiovascular Research and rather suspect it is yet another important-sounding clone journal designed specifically to sound good.
I no longer have any faith that big USA university hospital names mean anything.
I guess in a sense this is the mainstream now and yes it may be influential but that does not mean it isn't just empty cans jangling in the breeze.

I have not gone through in detail but I am pretty sure nothing can be concluded from this sort of study in which ascertainment bias is likely to be huge.

The Blitshteyn piece shows just how hyped things like this get.

 

I've highlighted the EDS and mast cell disorder figures in the tables of the two groups. Zero for both is suspicious and I can imagine have either as a pre-existing diagnosis might affect the individual's decision to vaccinate.

 

Interesting. I am more and more confused by this. It seems that the people who were vaccinated had ten times as many diagnoses of everything? So not exactly matched.