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Postural Orthostatic Tachycardia Syndrome (POTS) in Denmark: Increasingly recognized or new epidemic?

      Abstract

      Aims

      The incidence of Postural Orthostatic Tachycardia Syndrome (POTS) has grown in recent years. Whether this is an emerging epidemic or increasing recognition is unclear.

      Methods

      We retrospectively examined 8790 tilt-table tests (HUT) performed between 1997 and 2014 in patients with orthostatic intolerance and/or suspected syncope. Tests were reclassified according to the current diagnostic criteria for POTS. The number of POTS diagnoses in proportion to the number of tilt tests performed per year was calculated. The number of papers published with the term “Postural Orthostatic Tachycardia Syndrome” 1997–2014 was retrieved from PubMed and related to yearly POTS incidence.

      Results

      Eight-hundred-and-seventy-five tests with suspected POTS were thoroughly evaluated. The reclassification of test results yielded 243 POTS diagnoses (age, 27.0 ± 11.8 years). An increase in total number of POTS diagnoses was observed but the proportion of POTS-positive tests per year was relatively constant (≈2–3%) except for the period 2013–2014 (≈7%). The increase in POTS diagnoses was preceded by an increase in number of POTS-related papers in PubMed.

      Conclusion

      The proportion of POTS diagnoses among patients investigated for suspected syncope and/or orthostatic intolerance was relatively constant 1997–2012. The growing number of POTS-related publications in PubMed preceded the steep increase in diagnostic rate of POTS observed after 2012.
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      References

        • Aaron L.A.
        • Buchwald D.
        A review of the evidence for overlap among unexplained clinical conditions.
        Ann. Intern. Med. 2001; 134: 868-881
        • Bartoletti A.
        • Alboni P.
        • Ammirati F.
        • et al.
        ‘The Italian Protocol’: a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope.
        Europace. 2000; 2: 339-342
        • Benarroch E.E.
        Postural tachycardia syndrome: a heterogeneous and multifactorial disorder.
        Mayo Clin. Proc. 2012; 87: 1214-1225
        • Bjure A.
        • Laurell H.
        Abnormal static circulatory phenomena and their symptoms: arterial orthostatic anemia as neglected clinical picture.
        Upsala Lakareforen. Forh. 1927; 33: 1-23
        • Clayton E.W.
        Beyond myalgic encephalomyelitis/chronic fatigue syndrome: an IOM report on redefining an illness.
        JAMA. 2015; 313: 1101-1102
        • Collin S.M.
        • Bakken I.J.
        • Nazareth I.
        • Crawley E.
        • White P.D.
        Trends in the incidence of chronic fatigue syndrome and fibromyalgia in the UK, 2001–2013: a Clinical Practice Research Datalink study.
        J. R. Soc. Med. 2017; 110: 231-244
        • Collin S.M.
        • Bakken I.J.
        • Nazareth I.
        • Crawley E.
        • White P.D.
        Health care resource use by patients before and after a diagnosis of chronic fatigue syndrome (CFS/ME): a clinical practice research datalink study.
        BMC Fam. Pract. 2017; 18: 60
        • Da Costa J.
        On irritable heart: a clinical study of a form of a functional cardiac disorder and its consequences.
        Am J Med Sci. 1871; 61: 17-52
        • Fedorowski A.
        • Melander O.
        Syndromes of orthostatic intolerance: a hidden danger.
        J. Intern. Med. 2013; 273: 322-335
        • Fedorowski A.
        • Li H.
        • Yu X.
        • et al.
        Antiadrenergic autoimmunity in postural tachycardia syndrome.
        Europace. 2017; 19: 1211-1219
        • Grubb B.P.
        Postural tachycardia syndrome.
        Circulation. 2008; 117: 2814-2817
        • Kanjwal K.
        • Karabin B.
        • Kanjwal Y.
        • Grubb B.P.
        Autonomic dysfunction presenting as postural orthostatic tachycardia syndrome in patients with multiple sclerosis.
        Int. J. Med. Sci. 2010; 7: 62-67
        • Li H.
        • Yu X.
        • Liles C.
        • et al.
        Autoimmune basis for postural tachycardia syndrome.
        J. Am. Heart Assoc. 2014; 3e000755
        • Miller F.W.
        • Pollard K.M.
        • Parks C.G.
        • et al.
        Criteria for environmentally associated autoimmune diseases.
        J. Autoimmun. 2012; 39: 253-258
        • Okada H.
        • Kuhn C.
        • Feillet H.
        • Bach J.F.
        The hygiene hypothesis' for autoimmune and allergic diseases: an update.
        Clin. Exp. Immunol. 2010; 160: 1-9
        • Reynolds G.K.
        • Lewis D.P.
        • Richardson A.M.
        • Lidbury B.A.
        Comorbidity of postural orthostatic tachycardia syndrome and chronic fatigue syndrome in an Australian cohort.
        J. Intern. Med. 2014; 275: 409-417
        • Robertson D.
        The epidemic of orthostatic tachycardia and orthostatic intolerance.
        Am J Med Sci. 1999; 317: 75-77
        • Schondorf R.
        • Low P.A.
        Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?.
        Neurology. 1993; 43: 132-137
        • Sheldon R.S.
        • Grubb B.P.
        • Olshansky B.
        • et al.
        2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope.
        Heart Rhythm. 2015; 12e41-e63
        • Wallman D.
        • Weinberg J.
        • Hohler A.D.
        Ehlers-Danlos syndrome and postural tachycardia syndrome: a relationship study.
        J. Neurol. Sci. 2014; 340: 99-102