Clinical Presentation, Diagnostic Delays, and Treatment Outcomes in Postural Orthostatic Tachycardia Syndrome (POTS): An Observational Case Series Study in a Single-Centre District General Hospital

The cohort was predominantly female (n = 36, 97%) with a mean age of 28.2 years (SD, 8.3; range, 18-48). The most common presenting complaints were presyncope (49%) and presyncope with syncope (41%). These were often associated with palpitations and chest discomfort. Systemic conditions coexisting with POTS included anxiety/depression, hypermobility spectrum disorders (notably Ehlers-Danlos Syndrome), fibromyalgia, autoimmune diseases, and migraine. The median time to diagnosis was one year (IQR 1-4). However, delays of up to 20 years were observed. Speciality referrals involved cardiology (65%), neurology (13%), and internal medicine (10%). Management strategies included non-pharmacological therapy alone (19%), additionally pharmacological monotherapy (62%), and combination therapy with multiple drugs (19%). Symptomatic improvement was reported in 65% overall, with the highest rates observed in the multi-drug therapy group. This study highlights the demographic profile, burden of comorbidities, and diagnostic challenges in patients with POTS. Our single-centre study has demonstrated meaningful progress towards reducing the average time to diagnose POTS with varying treatment outcomes across therapeutic strategies. Multi-drug therapy in conjunction with non-pharmacological therapy proved to be the most efficacious in this cohort. These findings emphasise the importance of early recognition, streamlined referral pathways, and the need for further large-scale multi-centre research into patient-tailored, evidence-based management of POTS.