The POTS Label Debate: A Call for Reclassification

"The current label is not serving patients well, and in some cases, isn't serving doctors."
— Dr Susan Corcoran, Cardiologist

Overview

The term 'POTS' (postural orthostatic tachycardia syndrome) is being overused and misapplied, according to cardiologist Dr Susan Corcoran. She argues that the label fails to capture the complexity of orthostatic intolerance and overlaps with other conditions.

Key Criticisms

Misdiagnosis of Common Conditions

Dr Corcoran states that many patients diagnosed with POTS actually have more common conditions such as vasovagal syncope or orthostatic hypotension.

Overlooked Non-Cardiovascular Disorders

Focusing on heart rate can lead to missed diagnoses of non-cardiovascular disorders like Persistent Postural-Perceptual Dizziness (PPPD) or vestibular migraine.

A Broader Umbrella

Dr Corcoran suggests that chronic orthostatic intolerance could be included under the umbrella of chronic overlapping pain conditions (COPC), as many patients have overlapping symptoms.

A Lesson from PCOS

She cites the renaming of PCOS to PMOS as an example of how changing a label can better reflect a condition's broader presentation.

The Human and Clinical Impact

Disability and Work

• Claire Seeley, CEO of The Australian POTS Foundation, reports that 58% of POTS patients do not return to work, indicating significant disability.

Training Gaps

• A survey of 2,300 GPs found that only 3% had formal training in POTS.

Gender Disparity in Diagnosis

• Women account for 90% of POTS cases but take twice as long to receive a diagnosis compared to men.

Emergency Department Strain

• 60% of POTS patients visit emergency departments multiple times before diagnosis.

Dr Corcoran's Vision for Change

"I'm trying to give that person a sense of control. To say, ‘OK, this is what I see is happening with you. Let’s talk about strategies we can use in different circumstances.’”

She emphasizes the need for integrated clinics that address overlapping conditions like functional gut disorders, headache, and pain.

Conclusion

Dr Corcoran advocates for a shift away from the specific POTS label to improve understanding and management of orthostatic intolerance. The Australian POTS Foundation provides resources for GPs.