We sought to investigate the incidence of POTS in Olmsted County and its evolution over time.

We identified all patients in the clinical autonomic laboratory database of the Mayo Clinic Rochester from January 1^st 2000 through December 31^st 2016, who fulfilled 2011 consensus statement heart rate criteria for POTS during laboratory head-up tilt (increment ≥30 bpm if ≥20 years of age, ≥ 40 bpm if ≤19 years). Using the Rochester Epidemiology Project, we narrowed this search to those who were tested while residents of Olmstead County. The identified records were carefully reviewed to confirm a clinical diagnosis. Census counts for the Olmstead County population from 2000 to 2016 were gathered from government records (www.census.gov). Incidence was defined as the number of new cases per year among 100,000 residents.

A total of 17 years were reviewed (2000-2016) during which we identified 105 unique patients diagnosed with POTS while living in Olmsted County, 91 of which were female (89%). The mean age at diagnosis was 23.4 years [11-51].  The mean duration of documented orthostatic symptoms was 4.5 years. The most recent (2016) incidence rate was 6/100,000 person-year for the entire population (10.5/100,000 for women). The incidence rate among the age population at risk (10-54 years of age) in 2016 was 10.1/100,000 person-year (17.6/100,000 for women 10-54 years of age). The incidence rate for the total population showed a near four-fold increase from the year 2000 when the incidence was 1.6/100,000.

POTS is a disorder affecting predominantly young women. The steady rise of the incidence between 2000 and 2016 is intriguing, and may reflect an increased awareness of the syndrome among patients and physicians, but a true rise in incidence cannot be excluded.