Biological sex-dependent differences in postural orthostatic tachycardia syndrome
Marie‐Claire Seeley, Gemma Wilson, Eric Ong, A. Langdon, Jonathan Chieng, Danielle Bailey, Kristina Comacchio, Amanda J. Page, Dennis H. Lau, Celine Gallagher
Abstract
AIMS: This prospective, cross-sectional study aimed to identify sex-based differences in diagnostic and symptom experiences in postural orthostatic tachycardia syndrome (POTS). METHODS AND RESULTS: Data from participants ≥ 16 years with physician-confirmed POTS enrolled in the Australian POTS registry between 1 May 2021 and 30 April 2024 were analysed. Health-related quality of life was assessed using the EuroQol 5 Dimension tool. Composite autonomic symptom score (COMPASS-31) assessed autonomic symptom burden. Self-reported sociodemographic and diagnostic journey data informed diagnostic experiences. In total, 452 females (mean age 31.4 ± 11.4 years) and 48 males (mean age 31.1 ± 14.6 years) were included. Females experienced worse autonomic symptom burden (total COMPASS-31; 50.5 ± 13.7 vs. 42.4 ± 16.4 for men; P < 0.001). Both sexes interacted with an equivocal number of doctors (P = 0.763) and emergency departments (P = 0.830) before diagnosis. Females had significantly longer diagnostic delays than men (7.0 ± 8.6 vs. 3.8 ± 5.4 years; P = 0.010) and were 1.2.7 times more likely to experience ≥10 years of diagnostic delay (95% CI; 1.1-6.6). Despite the diagnostic latency and worse symptom burden, females reported similar, anxiety, depression, and health-related quality of life to men (global health rating where '100' = full health; females, 46.2 ± 20.4 vs. males, 43.7 ± 23.6; P = 0.485). CONCLUSION: Females and males with POTS experience significant differences in autonomic symptom burden and diagnostic delay. These differences do not seem to arise from sex-based variations in health-seeking behaviour or symptom reporting but rather indicate the influence of clinician-dependent factors. Further research is needed to explore how clinician attitudes may impact sex-dependent differences in diagnosis and treatment outcomes for those with POTS. REGISTRATION: ANZCTR:12621001034820.