The Evolution of Head-Upright Tilt-Table Testing in Toronto, Ontario, Canada: 2014-2024

The real-world use of head-upright tilt-table tests (HUTTs) in North America is not known. This single-centre retrospective study in Toronto, Ontario, Canada reports on 1063 HUTTs conducted between 2014 and 2024. Use of the HUTT increased year over year, with a greater increase in HUTTs conducted as a result of a referral diagnosis of postural orthostatic tachycardia syndrome (POTS). Using specific diagnostic criteria for syncope and POTS, patients with either diagnosis who underwent testing, after January 2021 had an almost 50% reduction in the odds of a positive HUTT (syncope: odds ratio: 0.54, 95% confidence interval: 0.40-0.73 and postural orthostatic tachycardia syndrome: odds ratio: 0.51, 95% confidence interval: 0.28-0.95).