Browsing by Author "Raj, Satish Ramnarayan"

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    The Impact and Treatment of Postural Orthostatic Tachycardia Syndrome
    (2024-04-24) Bourne, Kate; Raj, Satish Ramnarayan; Sheldon, Robert Stanley; Exner, Derek V.; Ahmed, Sofia B.; Mak, Susanna
    Background: Postural orthostatic tachycardia syndrome (POTS) is a debilitating cardiovascular autonomic nervous system disorder. Patients with POTS experience a high symptom burden and significant reductions in quality of life, but the full impacts of POTS were previously not fully understood. There are no approved medications for treating POTS, and evidence for off-label medication use and non-pharmacological treatments is of poor quality. Aims: The two aims of this program of research were to (1) investigate the multi-factorial impacts of POTS, and (2) evaluate compression garments as a potential non-pharmacological treatment. Methods: Aim 1 consisted of two studies: A large survey used to evaluate the economic and employment impacts of POTS, the role of sex differences in POTS, and the impact of pregnancy on POTS symptoms, and a survey of patients at a specialist autonomic centre to evaluate long-term outcomes of POTS. Aim 2 consisted of three studies: an in lab clinical trial of a proof-of-concept compression garment, an at home clinical trial using “real-world” compression garments, and a qualitative interview project evaluating the patient experience with compression garments. Results: Aim 1: Patients with POTS experience significant employment and economic impacts. Female patients with POTS experienced longer diagnostic delays and were more likely to be told their POTS was all in their head compared to male patients. Most patients who had been pregnant experienced a worsening of POTS symptoms during pregnancy. Over the long term, most patients with POTS continue to experience POTS symptoms. Aim 2: Body compression of the abdomen and legs reduces heart rate and improves symptoms by increasing stroke volume. Patients reported benefits from compression garments, as well as limitations; it is important for clinicians to be aware of this. Conclusions: Patients with POTS experience significant impacts including economic and employment loss, female patients with POTS experience a longer diagnostic delay than male patients, and most patients experience worse POTS symptoms during pregnancy. Compression garments are a cost-effective treatment that should be recommended for patients with POTS. Easy to implement treatments like compression garments may help to reduce symptom burden and negative impacts of POTS.