Patients With Postural Orthostatic Tachycardia Syndrome Who Have Psychiatric Disorders Experience Increased Treatment Failures
Samantha Tidd1, Amy Nowacki2, Tamanna Singh3, Robert Wilson4
1Cleveland Clinic Lerner College of Medicine, 2Dept. of Quantitative Health Sciences, 3Heart, Vascular, and Thoracic Institute, 4Department of Neuromuscular Medicine, Cleveland Clinic
Objective:
To investigate whether the presence of a psychiatric comorbidity results in a higher incidence of failed treatment courses in those with Postural Orthostatic Tachycardia Syndrome (POTS).
Background:
While POTS is not a psychiatric disease, it shares similar symptomatology with these disorders. In patients with concurrent psychiatric illness, it is challenging to determine which symptoms are sequelae of POTS versus underlying psychiatric conditions. To date, the mechanism by which the presence of psychiatric disorders impacts POTS treatment has yet to be studied.
Design/Methods:
The electronic medical records of 356 patients seen at our institution between 2018 and 2022 with confirmed POTS diagnoses via tilt table testing were extrapolated. Patients were sub-grouped based upon the presence or absence of a documented psychiatric disorder. The number of treatment course failures, defined as a change or discontinuation of a treatment regimen, after an initial visit with an institutional POTS specialist was collected. Preliminary results were obtained using data from 113 of 356 total patients, as this study is ongoing. Negative binomial regression was used to examine whether the presence of a psychiatric condition was associated with the number of POTS treatment course failures utilizing observation time as the offset term.
Results:
Our preliminary results suggest that patients with psychiatric disorders may have a higher POTS treatment failure incident rate than those without psychiatric conditions (incidence rate ratio (IRR) = 1.44, 95% confidence interval (0.78-2.64)).
Conclusions:
If this association remains after analysis of our entire patient cohort, anticipated by 3/1/2023, we suspect this patient population may (1) need increased counseling to recognize the impact of psychiatric disease on POTS therapy and (2) should be encouraged to seek treatment for these comorbidities.