Aim: This scoping review examined the key characteristics of empirical research and their clinical implications pertaining to diagnosis, symptomology and treatment across the postural tachycardia syndrome (PoTS) literature field.
Methods: An a priori protocol, article eligibility criteria and peer-reviewed systematic search strategy were first made available on Open Science Framework.1 The developed search strategy was deployed (initial = April 2019; updated = August 2022) across 5 academic databases from inception – PUBMED, CINAHL, Cochrane Library, Web of Science and ProQuest – to identify PoTS-relevant disseminations from all source types. Article screening and data extraction processes were independently undertaken by 2 reviewers, who demonstrated high inter-rater reliability agreement (Cohen’s K=0.815; 95% CI=0.658; 0.972). Alongside the undertaking of demographical analyses and identification of clinical implications through narrative synthesis, a fifteen thematic-coding framework was also developed to categorize the core focus of empirical works within the final article subset (N=654).
Results: Examination of article indicated a paucity of qualitative research (<1%) identified within the final review sample. PoTS empirical literature was dominated by works exploring: underlying aetiology (16.8%), paediatrics (14.2%), treatments (12.2%), comorbidities (12.1%) and diagnostic assessments (11.8%). Clinical implications drawn from narrative synthesis recommended the employment of psychometric tools, patient history and physiological markers to support PoTS diagnosis alongside chronic fatigue syndrome (<9 score on both Epworth Sleepiness Scale and Orthostatic Grading Scale), and its differentiation from vasovagal syncope diagnosis (consideration of historic psychiatric diagnosis, heightened norepinephrine levels and plasma H2S levels, examination of daytime ultra-low frequency heart-rate variabilities).
Conclusions: Our review findings highlight an urgent need for additional PoTS qualitative works to be undertaken to develop further understandings behind patients’ reported debilitating symptom experiences, poor quality of life and increased suicide ideation scores. Patient co-design qualitative research processes remain critical for supporting the development of novel PoTS interventions and the likelihood of their acceptability within this patient population. ❑
Figure 1: PRISMA flow diagram for the undertaken scoping review
