Date of Award
Spring 2021
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Lisa Murphy
Abstract
Introduction: Postural Orthostatic Tachycardia Syndrome (POTS) is a condition of chronic orthostatic intolerance and is associated with lightheadedness, palpitations, tremulousness, generalized weakness, blurred vision, exercise intolerance, and fatigue upon standing. Current guidelines from the Heart Rhythm Association were published in 2015. These guidelines recommend patients with POTS be prescribed an exercise regimen as first line therapy. If this is not effective, patients should then be prescribed a recommended pharmacotherapy. This paper will address the efficacy of several recommended pharmacotherapy options, compared to the first line treatment of exercise, to understand how to improve symptoms and quality of life in female patients of childbearing age with POTS.
Methods: A literature search was conducted through PubMed and ClinicalKey in November 2019. A total of seven articles consisting of 5 randomized control trials, 1 cohort study, and 1 retrospective study were selected based on publication date, relevance of the research question, and outcome measurements. The study design and results of these articles were then analyzed and compared.
Results: Based on the literature review there is evidence that the non-pharmaceutical treatment therapy of exercise programs may be efficacious in controlling symptoms of POTS, possibly regardless of subtype. The two studies that looked at exercised treatment programs provided statistically significant results that provide evidence this is an efficacious non-pharmaceutical therapy. However, the studies focusing on Propranolol, a beta-blocker, and Desmopressin did provide evidence that these pharmacotherapies were effective at improving symptoms of POTS.
Discussion: Important results were found in each of the articles whether they were discussing exercise therapy or pharmacological therapies. However, limited sample populations, lack of long-term data, and lack of selection from a broader pool of patients limit all findings from a higher statistical power of evidence. The evidence analyzed in these studies support the Heart Rhythm Society recommendations to implement exercise as a first line therapy in patients with POTS. And provide additional insight into which medications, in this case Propranolol, and Desmopressin, have evidence to support their efficacy at reducing symptoms in POTS. No negative health outcomes were recorded as a result of any of these studies and this topic of study should be encouraged to continue to look at long term data with larger sample populations.
Conclusion: Exercise should remain the first line treatment for patients with POTS and Propranolol and Desmopressin have been shown to have evidence supporting their efficacy if an exercise regimen does not relieve symptoms on its own. However, future studies should consider long-term follow up, improved recruitment techniques, and larger sample sizes to improve the statistical power of their results.
Recommended Citation
Wagor, Carson, "The Efficacy of Non-Pharmaceutical Therapy in the Treatment of Postural Orthostatic Tachycardia Syndrome" (2021). Capstone Showcase. 90.
https://scholarworks.arcadia.edu/showcase/2021/pa/90
The Efficacy of Non-Pharmaceutical Therapy in the Treatment of Postural Orthostatic Tachycardia Syndrome
Introduction: Postural Orthostatic Tachycardia Syndrome (POTS) is a condition of chronic orthostatic intolerance and is associated with lightheadedness, palpitations, tremulousness, generalized weakness, blurred vision, exercise intolerance, and fatigue upon standing. Current guidelines from the Heart Rhythm Association were published in 2015. These guidelines recommend patients with POTS be prescribed an exercise regimen as first line therapy. If this is not effective, patients should then be prescribed a recommended pharmacotherapy. This paper will address the efficacy of several recommended pharmacotherapy options, compared to the first line treatment of exercise, to understand how to improve symptoms and quality of life in female patients of childbearing age with POTS.
Methods: A literature search was conducted through PubMed and ClinicalKey in November 2019. A total of seven articles consisting of 5 randomized control trials, 1 cohort study, and 1 retrospective study were selected based on publication date, relevance of the research question, and outcome measurements. The study design and results of these articles were then analyzed and compared.
Results: Based on the literature review there is evidence that the non-pharmaceutical treatment therapy of exercise programs may be efficacious in controlling symptoms of POTS, possibly regardless of subtype. The two studies that looked at exercised treatment programs provided statistically significant results that provide evidence this is an efficacious non-pharmaceutical therapy. However, the studies focusing on Propranolol, a beta-blocker, and Desmopressin did provide evidence that these pharmacotherapies were effective at improving symptoms of POTS.
Discussion: Important results were found in each of the articles whether they were discussing exercise therapy or pharmacological therapies. However, limited sample populations, lack of long-term data, and lack of selection from a broader pool of patients limit all findings from a higher statistical power of evidence. The evidence analyzed in these studies support the Heart Rhythm Society recommendations to implement exercise as a first line therapy in patients with POTS. And provide additional insight into which medications, in this case Propranolol, and Desmopressin, have evidence to support their efficacy at reducing symptoms in POTS. No negative health outcomes were recorded as a result of any of these studies and this topic of study should be encouraged to continue to look at long term data with larger sample populations.
Conclusion: Exercise should remain the first line treatment for patients with POTS and Propranolol and Desmopressin have been shown to have evidence supporting their efficacy if an exercise regimen does not relieve symptoms on its own. However, future studies should consider long-term follow up, improved recruitment techniques, and larger sample sizes to improve the statistical power of their results.