Impact of age on postural tachycardia, autonomic symptom burden and quality-life in patients with orthostatic intolerance: nuances of using delta heart rate
G Wilson, B Nadlacki, M C Seeley, K Comacchio, J Chieng, D Bailey, E Ong, A Langdon, J Foote, N McCaffrey, C Gallagher, Dennis LauAbstract
Background/Introduction
In healthy individuals, others have shown a regression in orthostatic tachycardia with ageing. Yet, the orthostatic Delta heart rate (DHR) criterion used for those with Postural Orthostatic Tachycardia Syndrome (POTS) only has a cut-off of 30bpm for those >19 years old and 40bpm for those ≤19 years old. This may result in delayed or misdiagnosis of this debilitating condition.
Purpose
To explore the relationship between age and DHR, autonomic symptom burden and health-related quality-of-life (HrQoL) in individuals with orthostatic intolerance (OI).
Methods
This is a retrospective analysis of consecutive participants with symptoms of OI, referred for autonomic assessment between May-2021 and June-2024. Autonomic symptom burden and HrQoL were established via the Composite Autonomic Symptom Score [COMPASS-31; six domains: OI, vasomotor, secretomotor, gastrointestinal, bladder and pupillomotor], and the EuroQoL Visual Analogue Scale (EQ-VAS). DHR was determined via a 10-minute Active Stand Test, conducted as per international consensus. Correlations between age, and autonomic symptom burden, HrQoL and DHR were determined using Pearson’s or Spearman’s tests as appropriate.
Results
A total of 735 participants with OI were included [89.4% female; median age 30 (IQR 22–40) years; median DHR 32 (IQR 23–42)bpm; 79.5% POTS]. There was a negative correlation between age and DHR (r = -0.29, p < 0.001; Figure 1), indicating a decrease in orthostatic tachycardia with age. However, there was no significant correlation between age and overall autonomic symptom burden (Total COMPASS-31; r = -0.06, p = 0.13; Figure 2A). Interestingly, when the COMPASS-31 subdomain scores were evaluated, increasing age was found to correlate with lower burden of OI (r = -0.18, p < 0.001) and vasomotor (r = -0.12, p = 0.001) symptoms; but higher burden of bladder symptoms (r = 0.13, p < 0.001), with no significant correlation with secretomotor, gastrointestinal or pupillomotor symptoms (all p > 0.05). There was no evidence of a linear relationship between age and HrQoL (r = -0.01, p = 0.79; Figure 2B).
Conclusion/ Discussion
In a cohort of participants with OI, ageing was associated with a reduction in symptoms of OI and orthostatic tachycardia. While autonomic symptoms may manifest differently with ageing, there was no correlation between age and overall autonomic symptom burden or HrQoL. This data highlights the nuances of using DHR criterion in the evaluation and management of those with OI. A re-evaluation of the heart rate threshold for POTS diagnosis in older individuals may be warranted. Further research is needed to incorporate use of validated patient-reported outcome measures for broader autonomic assessment in addition to orthostatic testing for improved diagnosis and management of this complex syndrome.Age and Delta Heart RateAge and COMPASS-31 and HrQoL