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Malmö POTS symptom score : Assessing symptom burden in postural orthostatic tachycardia syndrome

Spahic, Jasmina Medic LU ; Hamrefors, Viktor LU orcid ; Johansson, Madeleine LU orcid ; Ricci, Fabrizio LU ; Melander, Olle LU orcid ; Sutton, Richard LU and Fedorowski, Artur LU orcid (2023) In Journal of Internal Medicine 293(1). p.91-99
Abstract

BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is a common cardiovascular autonomic disorder characterized by excessive heart rate (HR) increase on standing and symptoms of orthostatic intolerance, posing significant limitations on functional capacity. No objective tool exists to classify symptom burden in POTS.

METHODS: We conducted a case-control study in 62 POTS patients and 50 healthy controls to compare symptom burden between groups using the newly developed, self-rating, 12-item, Malmö POTS Score (MAPS; 0-10 per item, total range 0-120) based on patients own perception of symptoms through visual analogue scale assessment. We have also explored correlations between symptom severity assessed by MAPS, basic... (More)

BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is a common cardiovascular autonomic disorder characterized by excessive heart rate (HR) increase on standing and symptoms of orthostatic intolerance, posing significant limitations on functional capacity. No objective tool exists to classify symptom burden in POTS.

METHODS: We conducted a case-control study in 62 POTS patients and 50 healthy controls to compare symptom burden between groups using the newly developed, self-rating, 12-item, Malmö POTS Score (MAPS; 0-10 per item, total range 0-120) based on patients own perception of symptoms through visual analogue scale assessment. We have also explored correlations between symptom severity assessed by MAPS, basic clinical parameters and postural haemodynamic changes.

RESULTS: POTS patients showed significantly higher total MAPS score (78 ± 20 vs. 14 ± 12, p < 0.001), higher baseline systolic blood pressure (BP), diastolic BP and HR (p < 0.001) compared with healthy controls. The most prominent symptoms in POTS were palpitations, fatigue and concentration difficulties. Haemodynamic parameters on standing were significantly correlated with palpitations in POTS after adjustment for age and sex (lower systolic and diastolic BP, and higher HR) (p < 0.001 for all). Orthostatic HR was significantly associated with concentration difficulties and total MAPS score. The optimal cut-point value of MAPS to differentiate POTS and healthy controls was ≥42 (sensitivity, 97%; specificity, 98%).

CONCLUSIONS: Symptom severity, as assessed by MAPS score, is fivefold higher in POTS compared with healthy individuals. The new MAPS score can be useful as a semiquantitative system to assess symptom burden, monitor disease progression and evaluate pre-test likelihood of disease.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
POTS, Symptom assessment, Syncope, postural orthostatic tachycardia syndrome, score, Symptom burden
in
Journal of Internal Medicine
volume
293
issue
1
pages
9 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:36111700
  • scopus:85138081022
ISSN
1365-2796
DOI
10.1111/joim.13566
language
English
LU publication?
yes
additional info
© 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.
id
b468ccb2-8208-4dc7-a1aa-7683f45ce1b6
date added to LUP
2022-09-22 12:27:34
date last changed
2024-06-27 20:55:24
@article{b468ccb2-8208-4dc7-a1aa-7683f45ce1b6,
  abstract     = {{<p>BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is a common cardiovascular autonomic disorder characterized by excessive heart rate (HR) increase on standing and symptoms of orthostatic intolerance, posing significant limitations on functional capacity. No objective tool exists to classify symptom burden in POTS.</p><p>METHODS: We conducted a case-control study in 62 POTS patients and 50 healthy controls to compare symptom burden between groups using the newly developed, self-rating, 12-item, Malmö POTS Score (MAPS; 0-10 per item, total range 0-120) based on patients own perception of symptoms through visual analogue scale assessment. We have also explored correlations between symptom severity assessed by MAPS, basic clinical parameters and postural haemodynamic changes.</p><p>RESULTS: POTS patients showed significantly higher total MAPS score (78 ± 20 vs. 14 ± 12, p &lt; 0.001), higher baseline systolic blood pressure (BP), diastolic BP and HR (p &lt; 0.001) compared with healthy controls. The most prominent symptoms in POTS were palpitations, fatigue and concentration difficulties. Haemodynamic parameters on standing were significantly correlated with palpitations in POTS after adjustment for age and sex (lower systolic and diastolic BP, and higher HR) (p &lt; 0.001 for all). Orthostatic HR was significantly associated with concentration difficulties and total MAPS score. The optimal cut-point value of MAPS to differentiate POTS and healthy controls was ≥42 (sensitivity, 97%; specificity, 98%).</p><p>CONCLUSIONS: Symptom severity, as assessed by MAPS score, is fivefold higher in POTS compared with healthy individuals. The new MAPS score can be useful as a semiquantitative system to assess symptom burden, monitor disease progression and evaluate pre-test likelihood of disease.</p>}},
  author       = {{Spahic, Jasmina Medic and Hamrefors, Viktor and Johansson, Madeleine and Ricci, Fabrizio and Melander, Olle and Sutton, Richard and Fedorowski, Artur}},
  issn         = {{1365-2796}},
  keywords     = {{POTS; Symptom assessment; Syncope; postural orthostatic tachycardia syndrome; score; Symptom burden}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{91--99}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Internal Medicine}},
  title        = {{Malmö POTS symptom score : Assessing symptom burden in postural orthostatic tachycardia syndrome}},
  url          = {{http://dx.doi.org/10.1111/joim.13566}},
  doi          = {{10.1111/joim.13566}},
  volume       = {{293}},
  year         = {{2023}},
}