Symptom Presentation and Access to Medical Care in Patients With Postural Orthostatic Tachycardia Syndrome: Role of Sex, 2021, Kate M Bourne et al

Abstract

Background
Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance that primarily impacts female patients of childbearing age. The role of sex differences in POTS is not well understood. We sought to identify sex differences in diagnosis, symptoms, comorbidities, and treatments in female and male patients diagnosed with POTS.
Methods
A comprehensive survey was designed in partnership by Dysautonomia International (East Moriches, NY) and Vanderbilt University Medical Center (Nashville, TN). Patients were recruited through Dysautonomia International’s website and social media channels. The survey was delivered online through a secure research data capture database. Responses were analyzed according to biological sex. Continuous variables are presented as median (25th percentile-75th percentile), and categorical variables are presented as number and proportion of participants.
Results
A total of 8919 patients reported a physician diagnosis of POTS and were included in this analysis. The majority of respondents were female (93.7%). Female and male patients experienced misdiagnosis at similar rates (76.2% vs 74.9%, P = 0.5) and saw a similar number of doctors before diagnosis (5 [3-8] vs 5 [3-8], P = 0.9). Despite these similarities, diagnostic delay was longer for female, compared with male, patients (1.50 [0.25-5.25] years vs 0.92 [0.08-2.91] years, P < 0.001).
Conclusions
Despite the primarily female demographic of POTS patients, female patients experience more challenges with diagnosis than male patients. Increased awareness and recognition of POTS may help to reduce the diagnostic challenges in both female and male patients, and improve treatment and management for individuals living with this debilitating disorder.

https://www.cjcopen.ca/article/S2589-790X(21)00231-6/fulltext

 

Those numbers are a massive undercount, do not account that the vast majority are never diagnosed. So the misdiagnosis rates and delays to diagnosis are basically a rosy picture that represents the best case scenarios. Denominators are important.

What good is awareness and recognition if this isn't accurately taught in medical school? Who is supposed to be made more aware of this? No one ever seems to specify that, or think of it beyond a generic platitude.

 

I found this very informative.

A minor point is they state it primarily effects woman of childbearing age but they did not include the ages of the people surveyed. Would we presume that post-menopausal women are not affected by POTS?

However I do think the article is more on reflecting the range of presentation and comorbidities and medical practitioners attributing symptoms to psychogical causes.

It was also interesting that more men were on desmopressin which they did not expand on why, I presume this is a sex difference too.