Characterisation of Postural Orthostatic Tachycardia Syndrome (POTS): Findings from a physician chart-audit pre- and post-COVID-19.

This multi-country physician chart review of 599 patients describes what POTS looks like in everyday clinical practice, both before and after COVID-19 became a common trigger. Most patients developed symptoms between ages 18–39, some before age 18, and over 70% had at least one other medical condition. Diagnosis was complex and delayed: patients typically had 5–8 tests, about 80% were first given other (incorrect) diagnoses, and one-quarter waited more than a year before POTS was confirmed. Symptoms often lessened somewhat over time but generally persisted. First-line care relied heavily on non-drug strategies (like fluids, salt, compression, lifestyle changes), and later treatment lines increasingly added medications, most often beta-blockers and ivabradine. When comparing patients whose POTS was triggered by COVID-19 with those whose POTS had other triggers, the groups were broadly similar: COVID-related patients were a bit older and had fewer comorbidities, but diagnostic paths, management patterns, and treatments were essentially alike. The study also found differences between US and European practice patterns. Overall, the findings underscore substantial diagnostic delays, ongoing symptom burden, and variable real-world treatment approaches for POTS, regardless of whether onset followed COVID-19.