{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:29:48Z","timestamp":1787315388061,"version":"build-2736575974"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T00:00:00Z","timestamp":1742947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This prospective, cross-sectional study aimed to identify sex-based differences in diagnostic and symptom experiences in postural orthostatic tachycardia syndrome (POTS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Data from participants \u2265 16 years with physician-confirmed POTS enrolled in the Australian POTS registry between 1 May 2021 and 30 April 2024 were analysed. Health-related quality of life was assessed using the EuroQol 5 Dimension tool. Composite autonomic symptom score (COMPASS-31) assessed autonomic symptom burden. Self-reported sociodemographic and diagnostic journey data informed diagnostic experiences. In total, 452 females (mean age 31.4 \u00b1 11.4 years) and 48 males (mean age 31.1 \u00b1 14.6 years) were included. Females experienced worse autonomic symptom burden (total COMPASS-31; 50.5 \u00b1 13.7 vs. 42.4 \u00b1 16.4 for men; P &amp;lt; 0.001). Both sexes interacted with an equivocal number of doctors (P = 0.763) and emergency departments (P = 0.830) before diagnosis. Females had significantly longer diagnostic delays than men (7.0 \u00b1 8.6 vs. 3.8 \u00b1 5.4 years; P = 0.010) and were 1.2.7 times more likely to experience \u226510 years of diagnostic delay (95% CI; 1.1\u20136.6). Despite the diagnostic latency and worse symptom burden, females reported similar, anxiety, depression, and health-related quality of life to men (global health rating where \u2018100\u2019 = full health; females, 46.2 \u00b1 20.4 vs. males, 43.7 \u00b1 23.6; P = 0.485).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Females and males with POTS experience significant differences in autonomic symptom burden and diagnostic delay. These differences do not seem to arise from sex-based variations in health-seeking behaviour or symptom reporting but rather indicate the influence of clinician-dependent factors. Further research is needed to explore how clinician attitudes may impact sex-dependent differences in diagnosis and treatment outcomes for those with POTS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>ANZCTR:12621001034820<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjcn\/zvaf048","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T18:40:44Z","timestamp":1743273644000},"page":"762-771","source":"Crossref","is-referenced-by-count":10,"title":["Biological sex-dependent differences in postural orthostatic tachycardia syndrome"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8430-1489","authenticated-orcid":false,"given":"Marie-Claire","family":"Seeley","sequence":"first","affiliation":[{"name":"Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide ,","place":["Australia"]},{"name":"South Australian Health and Medical Research Institute, Adelaide, South Australia ,","place":["Australia"]},{"name":"Rosmary Bryant AO Research Centre, Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9072-2264","authenticated-orcid":false,"given":"Gemma","family":"Wilson","sequence":"additional","affiliation":[{"name":"Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide ,","place":["Australia"]},{"name":"South Australian Health and Medical Research Institute, Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6181-3480","authenticated-orcid":false,"given":"Eric","family":"Ong","sequence":"additional","affiliation":[{"name":"Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide ,","place":["Australia"]},{"name":"Department of Cardiology, Royal Adelaide Hospital , South Australia ,","place":["Australia"]},{"name":"College of Medicine and Public Health, Flinders University , South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7644-9863","authenticated-orcid":false,"given":"Amy","family":"Langdon","sequence":"additional","affiliation":[{"name":"Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide ,","place":["Australia"]},{"name":"College of Medicine and Public Health, Flinders University , South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5257-9929","authenticated-orcid":false,"given":"Jonathan","family":"Chieng","sequence":"additional","affiliation":[{"name":"Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide ,","place":["Australia"]},{"name":"Department of Cardiology, Royal Adelaide Hospital , South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6375-8487","authenticated-orcid":false,"given":"Danielle","family":"Bailey","sequence":"additional","affiliation":[{"name":"Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2754-8263","authenticated-orcid":false,"given":"Kristina","family":"Comacchio","sequence":"additional","affiliation":[{"name":"Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide ,","place":["Australia"]},{"name":"South Australian Health and Medical Research Institute, Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7086-5865","authenticated-orcid":false,"given":"Amanda J","family":"Page","sequence":"additional","affiliation":[{"name":"Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide ,","place":["Australia"]},{"name":"South Australian Health and Medical Research Institute, Adelaide, South Australia ,","place":["Australia"]},{"name":"School of Biomedicine, The University of Adelaide , Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7753-1318","authenticated-orcid":false,"given":"Dennis H","family":"Lau","sequence":"additional","affiliation":[{"name":"Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide ,","place":["Australia"]},{"name":"South Australian Health and Medical Research Institute, Adelaide, South Australia ,","place":["Australia"]},{"name":"Department of Cardiology, Royal Adelaide Hospital , South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5114-400X","authenticated-orcid":false,"given":"Celine","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide ,","place":["Australia"]},{"name":"South Australian Health and Medical Research Institute, Adelaide, South Australia ,","place":["Australia"]},{"name":"Rosmary Bryant AO Research Centre, Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,3,26]]},"reference":[{"key":"2025072111514670800_zvaf048-B1","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s10286-023-00955-9","article-title":"Poor health-related quality of life in postural orthostatic tachycardia syndrome in comparison with a sex- and age-matched normative population","volume":"33","author":"Seeley","year":"2023","journal-title":"Clin Auton Res"},{"key":"2025072111514670800_zvaf048-B2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.2147\/NRR.S394822","article-title":"Postural orthostatic tachycardia syndrome: diagnosis and management guide for nurses","volume":"13","author":"Seeley","year":"2023","journal-title":"Nursi Res Rev"},{"key":"2025072111514670800_zvaf048-B3","first-page":"357","article-title":"Canadian Cardiovascular Society Position Statement on postural orthostatic tachycardia syndrome (POTS) and related disorders of chronic orthostatic intolerance","volume":"36","author":"Raj","year":"2020","journal-title":"Can J Cardiol"},{"key":"2025072111514670800_zvaf048-B4","doi-asserted-by":"crossref","first-page":"E378","DOI":"10.1503\/cmaj.211373","article-title":"Diagnosis and management of postural orthostatic tachycardia syndrome","volume":"194","author":"Raj","year":"2022","journal-title":"CMAJ"},{"key":"2025072111514670800_zvaf048-B5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/VHRM.S127393","article-title":"Postural tachycardia syndrome: current perspectives","volume":"14","author":"Wells","year":"2017","journal-title":"Vasc Health Risk Manag"},{"key":"2025072111514670800_zvaf048-B6","first-page":"33","article-title":"A profile of patients with postural tachycardia syndrome and their experience of healthcare in the UK","volume":"23","author":"Kavi","year":"2016","journal-title":"Br J Cardiol"},{"key":"2025072111514670800_zvaf048-B7","doi-asserted-by":"crossref","first-page":"102790","DOI":"10.1016\/j.autneu.2021.102790","article-title":"Raising the bar in postural orthostatic tachycardia syndrome research: evidence and challenges","volume":"233","author":"Seeley","year":"2021","journal-title":"Auton Neurosci"},{"key":"2025072111514670800_zvaf048-B8","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1161\/CIRCRESAHA.122.320259","article-title":"Illuminating the mechanisms underlying sex differences in cardiovascular disease","volume":"130","author":"Reue","year":"2022","journal-title":"Circ Res"},{"key":"2025072111514670800_zvaf048-B9","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/B978-0-323-85492-4.00056-9","volume-title":"Primer on the Autonomic Nervous System","author":"Fu","year":"2023","edition":"4th ed"},{"key":"2025072111514670800_zvaf048-B10","doi-asserted-by":"crossref","first-page":"H1270","DOI":"10.1152\/ajpheart.00477.2022","article-title":"Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease","volume":"323","author":"Lee","year":"2022","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"2025072111514670800_zvaf048-B11","doi-asserted-by":"crossref","first-page":"153","DOI":"10.5694\/mja2.51220","article-title":"Sex differences in the management and outcomes of non-ST-elevation acute coronary syndromes","volume":"216","author":"Bachelet","year":"2022","journal-title":"Med J Aust"},{"key":"2025072111514670800_zvaf048-B12","doi-asserted-by":"crossref","first-page":"cvae088.054","DOI":"10.1093\/cvr\/cvae088.054","article-title":"Sex differences in optimal medical therapy following invasive angiography for coronary artery disease","volume":"120","author":"Sullivan","year":"2024","journal-title":"Cardiovasc Res"},{"key":"2025072111514670800_zvaf048-B13","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.jacbts.2021.11.003","article-title":"Research opportunities in autonomic neural mechanisms of cardiopulmonary regulation: a report from the national heart, lung, and blood institute and the national institutes of health office of the director workshop","volume":"7","author":"Mehra","year":"2022","journal-title":"JACC Basic Transl Sci"},{"key":"2025072111514670800_zvaf048-B14","doi-asserted-by":"crossref","first-page":"e3","DOI":"10.1136\/heartjnl-2024-324625","article-title":"Advancing the access to cardiovascular diagnosis and treatment among women with cardiovascular disease: a joint British Cardiovascular Societies\u2019 consensus document","volume":"110","author":"Tayal","year":"2024","journal-title":"Heart"},{"key":"2025072111514670800_zvaf048-B15","first-page":"e43569","article-title":"The impact of menopause on cardiovascular aging: a comprehensive review of androgen influences","volume":"15","author":"Raj","year":"2023","journal-title":"Cureus"},{"key":"2025072111514670800_zvaf048-B16","doi-asserted-by":"crossref","first-page":"969325","DOI":"10.3389\/fcvm.2022.969325","article-title":"Gender-based time discrepancy in diagnosis of coronary artery disease based on data analytics of electronic medical records","volume":"9","author":"Panahiazar","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"2025072111514670800_zvaf048-B17","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/joim.12895","article-title":"The face of postural tachycardia syndrome\u2014insights from a large cross-sectional online community-based survey","volume":"286","author":"Shaw","year":"2019","journal-title":"J Intern Med"},{"key":"2025072111514670800_zvaf048-B18","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"2025072111514670800_zvaf048-B19","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"2025072111514670800_zvaf048-B20","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/s12955-016-0537-0","article-title":"Health-related quality of life measured using the EQ-5D-5L: South Australian population norms","volume":"14","author":"McCaffrey","year":"2016","journal-title":"Health Qual Life Outcomes"},{"key":"2025072111514670800_zvaf048-B21","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/hec.3564","article-title":"Valuing health-related quality of life: an EQ-5D-5L value set for England","volume":"27","author":"Devlin","year":"2018","journal-title":"Health Econ"},{"key":"2025072111514670800_zvaf048-B22","doi-asserted-by":"crossref","first-page":"e0180744","DOI":"10.1371\/journal.pone.0180744","article-title":"The composite autonomic symptom scale 31 is a useful screening tool for patients with parkinsonism","volume":"12","author":"Kim","year":"2017","journal-title":"PLoS One"},{"key":"2025072111514670800_zvaf048-B23","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1016\/j.mayocp.2012.10.013","article-title":"COMPASS 31: a refined and abbreviated Composite Autonomic Symptom Score","volume":"87","author":"Sletten","year":"2012","journal-title":"Mayo Clin Proc"},{"key":"2025072111514670800_zvaf048-B24","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/joim.13566","article-title":"Malmo POTS symptom score: assessing symptom burden in postural orthostatic tachycardia syndrome","volume":"293","author":"Spahic","year":"2023","journal-title":"J Intern Med"},{"key":"2025072111514670800_zvaf048-B25","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1001\/archneur.1989.00520460115022","article-title":"The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus","volume":"46","author":"Krupp","year":"1989","journal-title":"Arch Neurol"},{"key":"2025072111514670800_zvaf048-B26","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/j.1742-1241.2003.tb10455.x","article-title":"A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain","volume":"57","author":"Hakim","year":"2003","journal-title":"Int J Clin Pract"},{"key":"2025072111514670800_zvaf048-B27","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/1471-2288-12-78","article-title":"t-Tests, non-parametric tests, and large studies\u2014a paradox of statistical practice?","volume":"12","author":"Fagerland","year":"2012","journal-title":"BMC Med Res Methodol"},{"key":"2025072111514670800_zvaf048-B28","first-page":"S367","article-title":"Various aspects of sex and gender bias in biomedical research","volume":"69","author":"Plevkova","year":"2020","journal-title":"Physiol Res"},{"key":"2025072111514670800_zvaf048-B29","first-page":"1016","article-title":"\u201cI just want to feel safe going to a doctor\u201d: experiences of female patients with chronic conditions in Australia","volume":"3","author":"Merone","year":"2022","journal-title":"Womens Health Rep (New Rochelle)"},{"key":"2025072111514670800_zvaf048-B30","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1212\/WNL.43.1_Part_1.132","article-title":"Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?","volume":"43","author":"Schondorf","year":"1993","journal-title":"Neurology"},{"key":"2025072111514670800_zvaf048-B31","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1111\/ene.12717","article-title":"Validation of the composite autonomic symptom scale 31 (COMPASS-31) in patients with and without small fiber polyneuropathy","volume":"22","author":"Treister","year":"2015","journal-title":"Eur J Neurol"},{"key":"2025072111514670800_zvaf048-B32","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.amjmed.2023.06.010","article-title":"High incidence of autonomic dysfunction and postural orthostatic tachycardia syndrome in patients with long-COVID: implications for management and healthcare planning","volume":"138","author":"Seeley","year":"2025","journal-title":"Am J Med"},{"key":"2025072111514670800_zvaf048-B33","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1038\/s44161-022-00180-z","article-title":"The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection: more studies are needed","volume":"1","author":"Blitshteyn","year":"2022","journal-title":"Nat Cardiovasc Res"},{"key":"2025072111514670800_zvaf048-B34","first-page":"767","article-title":"Objective hemodynamic cardiovascular autonomic abnormalities in post-acute sequelae of COVID-19","volume":"39","author":"Hira","year":"2023","journal-title":"Can J Cardiol"},{"key":"2025072111514670800_zvaf048-B35","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ejim.2024.06.023","article-title":"Autonomic dysfunction in post-acute sequelae of COVID-19","volume":"127","author":"Seeley","year":"2024","journal-title":"Eur J Intern Med"},{"key":"2025072111514670800_zvaf048-B36","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1177\/0961203314524468","article-title":"Postural tachycardia syndrome (POTS) and other autonomic disorders in antiphospholipid (Hughes) syndrome (APS)","volume":"23","author":"Schofield","year":"2014","journal-title":"Lupus"},{"key":"2025072111514670800_zvaf048-B37","doi-asserted-by":"crossref","first-page":"4406","DOI":"10.1007\/s10620-020-06808-z","article-title":"Regional gastrointestinal transit and contractility patterns vary in postural orthostatic tachycardia syndrome (POTS)","volume":"66","author":"Zhou","year":"2021","journal-title":"Dig Dis Sci"},{"key":"2025072111514670800_zvaf048-B38","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1111\/head.13659","article-title":"Dysautonomia and headache in the pediatric population","volume":"59","author":"Wig","year":"2019","journal-title":"Headache"},{"key":"2025072111514670800_zvaf048-B39","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.ijgo.2012.04.014","article-title":"Gynecologic disorders and menstrual cycle lightheadedness in postural tachycardia syndrome","volume":"118","author":"Peggs","year":"2012","journal-title":"Int J Gynaecol Obstet"},{"key":"2025072111514670800_zvaf048-B40","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s12974-020-01752-1","article-title":"Autonomic nervous system and inflammation interaction in endometriosis-associated pain","volume":"17","author":"Wei","year":"2020","journal-title":"J Neuroinflammation"},{"key":"2025072111514670800_zvaf048-B41","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","year":"2020","journal-title":"N Engl J Med"},{"key":"2025072111514670800_zvaf048-B42","first-page":"1","volume-title":"Cat. No. PHE 247","author":"AIHW","year":"2019"}],"container-title":["European Journal of Cardiovascular Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjcn\/advance-article-pdf\/doi\/10.1093\/eurjcn\/zvaf048\/62741327\/zvaf048.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjcn\/article-pdf\/24\/5\/762\/62741327\/zvaf048.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjcn\/article-pdf\/24\/5\/762\/62741327\/zvaf048.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T15:51:55Z","timestamp":1753113115000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjcn\/article\/24\/5\/762\/8095354"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,26]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3,26]]},"published-print":{"date-parts":[[2025,7,21]]}},"URL":"https:\/\/doi.org\/10.1093\/eurjcn\/zvaf048","relation":{},"ISSN":["1474-5151","1873-1953"],"issn-type":[{"value":"1474-5151","type":"print"},{"value":"1873-1953","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7]]},"published":{"date-parts":[[2025,3,26]]}}}