A prospective, 1-year follow-up study of postural tachycardia syndrome
Open accessAbstract
Objective To prospectively evaluate patients who met standard criteria for postural tachycardia syndrome (POTS), at baseline and 1-year follow-up, using standard clinical and laboratory methods to assess autonomic function.Methods Fifty-eight patients met the study criteria (orthostatic symptoms and a heart rate increment of ≥ 30 beats/min on head-up tilt) and completed 12 months of follow-up. All patients were enrolled and completed the study from January 16, 2006, through April 15, 2009. Patients underwent standardized autonomic testing, including head-up tilt, clinical assessment, and validated questionnaires designed to determine the severity of autonomic symptoms.Results Patients were predominantly young females (n=49, 84%), with 20 patients (34%) reporting an antecedent viral infection before onset of symptoms. More than one-third (37%) no longer fulfilled tilt criteria for POTS on follow-up, although heart rate increment on head-up tilt did not differ significantly at 1 year (33.8 ± 15.1 beats/min) compared with baseline (37.8 ± 14.6 beats/min) for the entire cohort. Orthostatic symptoms improved in most patients. Autonomic dysfunction was mild as defined by a Composite Autonomic Severity Score of 3 or less in 55 patients (95%) at baseline and 48 patients (92%) at 1 year.Conclusion To our knowledge, this is the first prospective study of the clinical outcomes of patients with POTS. Orthostatic symptoms improved in our patients, with more than one-third of patients no longer fulfilling tilt criteria for POTS, although the overall group change in heart rate increment was modest. Our data are in keeping with a relatively favorable prognosis in most patients with POTS.
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Medium-high quality longitudinal evaluation of POTS found a reduction of symptom burden over time.
“Medium-high quality longitudinal evaluation of POTS found a reduction of symptom burden over time (Dipaola et al., 2020”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Kimpinski et al., 2012
A study using the Composite Autonomic Severity Score (CASS) reported only mild autonomic dysfunction in people with POTS (score of 3 or less in 95% of patients at baseline and 92% at 1 year).
“a study which used an objective measurement of autonomic dysfunction in people with POTS (the Composite Autonomic Severity Score, CASS) reported only mild autonomic dysfunction (a score of 3 or less in 95 % of patients at baseline and 92 % at 1 year) (Kimpinski et al., 2012”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Kimpinski et al., 2012
In a prospective one-year follow-up study, over one-third of adult POTS patients no longer met POTS criteria during head-up tilt testing, and orthostatic symptoms improved.
“This study showed orthostatic symptom improvement and that over one-third of patients no longer met criteria for POTS during HUTT at follow-up (Kimpinski et al., 2012).”
From Postural tachycardia syndrome – Diagnosis, physiology, and prognosis (2018) · cites this paper as Kimpinski et al., 2012
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Vuong, D. T. A., Moak, J. P., Verghese, S. T., & Kane, T. D. (2021) · Springer eBooks · doi:10.1007/978-3-030-72551-8_14 · Cited by 1 · see citing works
Recognizing postural orthostatic tachycardia syndrome in primary care
Hulsey, B. (2023) · JAAPA · doi:10.1097/01.jaa.0000991396.00397.be · Cited by 1 · see citing works
Nurse-Led PoTS Clinics: A Framework
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Vincent, A., Whipple, M. O., Low, P. A., Joyner, M. J., & Hoskin, T. L. (2016)
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Self-citationHamam, I. R. T., Holy, A. A., Darwish, O., Alkhalaileh, B., Abdulelah, A., Shaaban, S., Qudah, S. A., Amro, M., Shakhatreh, A., Alkarmi, A., et al. (2025) · Cardio-Oncology · doi:10.1186/s40959-025-00379-6
Lived experiences and perspectives of persons with conditions marked by autonomic dysfunction
Shah, L., Kinser, P. A., Moyer, S., Rider, A., Kang, L., Decker, R., Feliciano, D., Lantz, L., Crouch, T. B., Popoff, E. E., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0355952
Postural Orthostatic Tachycardia Syndrome (POTS)
Chung, T., & Raj, S. R. (2026) · JAMA · doi:10.1001/jama.2026.14809
Seeley, M., Wilson, G., Ong, E., Langdon, A., Chieng, J., Bailey, D., Comacchio, K., Page, A. J., Lau, D. H., & Gallagher, C. (2026) · BMJ Open · doi:10.1136/bmjopen-2026-119165
- Authors
- Kimpinski, K., Figueroa, J. J., Singer, W., Sletten, D. M., Iodice, V., Sandroni, P., Fischer, P. R., Opfer-Gehrking, T. L., Gehrking, J. A., & Low, P. A.
- Affiliations
- Western University (CA)
- Mayo Clinic (US)
- Imperial College London (GB)
- Corresponding author
- Low, Phillip A.
- Venue
- Mayo Clinic Proceedings
- Publisher
- Elsevier BV
- Published
- 2012-08
- Volume
- 87
- Issue
- 8
- Pages
- 746-752
- ISSN
- 0025-6196 (ISSN-L)
- PMC
- PMC3538485
- OpenAlex
- W2034837154
- Cited by
- 81
- References
- 20
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 4 · 2020: 8 · 2019: 6 · 2018: 8 · 2017: 6 · 2016: 7 · 2015: 6 · 2014: 9 · 2013: 2
- FWCI
- 5.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Mayo Clinic Proceedings (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Georgia Clinical and Translational Science Alliance
- Rare Diseases Clinical Research Network
- National Institutes of Health (n01ns032352-003, NS4 4233, NS3 2352, RR24150)
- National Institute of Neurological Disorders and Stroke (NS3 2352, P01NS044233, P50NS032352, NS-44233, N01 NS032352, U54NS065736)
- National Center for Research Resources (UL1RR24150, UL1RR024150)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- postural orthostatic tachycardia syndrome, autonomic dysfunction, orthostatic symptoms, head-up tilt, prognosis, long-term follow-up
- MeSH terms
- Adult, Anti-Inflammatory Agents, Atenolol, Cholinesterase Inhibitors, Female, Fludrocortisone, Follow-Up Studies, Heart Rate, Humans, Male, Metoprolol, Midodrine, Nadolol, Norepinephrine, Propranolol, Prospective Studies, Pyridostigmine Bromide, Severity of Illness Index, Sodium, Virus Diseases, Tilt-Table Test, Postural Orthostatic Tachycardia Syndrome, Adrenergic alpha-1 Receptor Agonists, Adrenergic beta-1 Receptor Antagonists
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