Article published in Autonomic Neuroscience: Basic & Clinical by Satish Raj, Kate Bourne, Lauren Stiles, Mitchell Miglis, Melissa Cortez, Amanda Miller, Roy Freeman, Italo Biaggioni, Peter Rowe, Robert Sheldon, Cyndya Shibao, Andre Diedrich, David Systrom, Glen Cook, Taylor Doherty, Hasan Abdallah, Blair Grubb, Artur Fedorowski, Julian Stewart, Amy Arnold, Laura Pace, Jonas Axelsson, Jeffrey Boris, Jeffrey Moak, Brent Goodman, Kamal Chémali, Tae Chung, David Goldstein, Anil Darbari, Steven Vernino
The National Institutes of Health hosted a workshop in 2019 to build consensus around the current state of understanding of the pathophysiology of postural orthostatic tachycardia syndrome (POTS) and to identify knowledge gaps that must be addressed to enhance clinical care of POTS patients through research. This second (of two) articles summarizes current knowledge gaps, and outlines the clinical and research priorities for POTS. POTS is a complex, multi-system, chronic disorder of the autonomic nervous system characterized by orthostatic intolerance and orthostatic tachycardia without hypotension. Patients often experience a host of other related disabling symptoms. The functional and economic impacts of this disorder are significant. The pathophysiology remains incompletely understood. Beyond the significant gaps in understanding the disorder itself, there is a paucity of evidence to guide treatment which can contribute to suboptimal care for this patient population. The vast majority of physicians have minimal to no familiarity or training in the assessment and management of POTS. Funding for POTS research remains very low relative to the size of the patient population and impact of the syndrome. In addition to efforts to improve awareness and physician education, an investment in research infrastructure including the development of standardized disease-specific evaluation tools and outcome measures is needed to facilitate effective collaborative research. A national POTS research consortium could facilitate well-controlled multidisciplinary clinical research studies and therapeutic trials. These priorities will require a substantial increase in the number of research investigators and the amount of research funding in this area.