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Utilisation of medications to reduce symptoms in children with postural orthostatic tachycardia syndrome

Published online by Cambridge University Press:  06 August 2018

Jeffrey R. Boris Open the ORCID record for Jeffrey R. Boris [Opens in a new window]  and
Thomas Bernadzikowski
Jeffrey R. Boris*
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Thomas Bernadzikowski
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Author for correspondence: J. R. Boris, MD, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Division of Cardiology, Philadelphia, PA 19104, USA. Tel: 215 590 3180; Fax: 267 426 5324; E-mail: borisj@email.chop.edu
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Abstract

Background

Postural orthostatic tachycardia syndrome encompasses multiple disabling symptoms that interfere with daily activities. Non-pharmacologic approaches can be insufficient and can require adjunctive medications to manage symptoms. Minimal data exist in the literature on medication outcomes in these patients. We reviewed our database for medication management outcomes.

Materials and Methods

Patients aged 18 years and younger at initial diagnosis met the inclusion criteria. All prescribed patient medications were extracted from the electronic health record, excluding medications for unrelated symptoms or comorbid diseases. Medications were grouped by symptom class consistent with our programme utilisation protocol. Within symptom classification, therapy was deemed successful when a specific dose was prescribed at least five consecutive times without changes; this was confirmed by chart review. Individual medications and overall percentage of successful therapies within symptom classifications were assessed, with further analysis by gender. t-Test, χ2, and Mann–Whitney U-test were used to assess for differences in specific variables, as appropriate.

Results

A total of 708 patients met the study criteria. The percentage of patients with effective therapy by symptom includes light-headedness (52.2%), headache (48.2%), nausea (39.1%), dysmotility (43.4%), pain (53.4%), and insomnia (42.8%). Insomnia therapy was better for females; all other therapies showed no gender difference. The median number of therapies prescribed per patient per symptom was 2 for light-headedness, headache, and insomnia, and 1 for nausea, dysmotility, and pain.

Discussion

Symptoms associated with this disorder can be effectively managed with various medications. Further randomised studies are needed to better ascertain true efficacy compared with placebo.

Keywords

Dysautonomialight-headednessheadachedysmotilityinsomnia
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 12 , December 2018 , pp. 1386 - 1392
Copyright
© Cambridge University Press 2018 

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