Prognosis and survival of older dizzy patients in primary care: a 10-year prospective cohort study
Prognosis and survival of older dizzy patients in primary care: a 10-year prospective cohort study
PURPOSE The prognosis of older patients with dizziness in primary care is unknown. Our objective was to determine the prognosis and survival of patients with different subtypes and causes of dizziness. METHODS In a primary care prospective cohort study, 417 older adults with dizziness (mean age 79 years) received a full diagnostic workup in 2006-2008. A panel of physicians classified the subtype and primary cause of dizziness. Main outcome measures were mortality and dizziness-related impairment assessed at 10-year follow-up. RESULTS At 10-year follow-up 169 patients (40.5%) had died. Presyncope was the most common dizziness subtype (69.1%), followed by vertigo (41.0%), dis-equilibrium (39.8%), and other dizziness (1.7%). The most common primary causes of dizziness were cardiovascular disease (56.8%) and peripheral vestibular disease (14.4%). Multivariable adjusted Cox models showed a lower mortality rate for patients with the subtype vertigo compared with other subtypes (hazard ratio [HR] = 0.62; 95% CI, 0.40-0.96), and for peripheral vestibular disease vs cardiovascular disease as primary cause of dizziness (HR = 0.46; 95% CI, 0.25-0.84). After 10 years, 47.7% of patients who filled out the follow-up measurement experienced substantial dizziness-related impairment. No significant difference in substantial impairment was seen between different subtypes and primary causes of dizziness. CONCLUSIONS The 10-year mortality rate was lower for the dizziness subtype vertigo compared with other subtypes. Patients with dizziness primarily caused by peripheral vestibular disease had a lower mortality rate than patients with cardiovascular disease. Substantial dizziness-related impairment in older patients with dizziness 10 years later is high, and indicates that current treatment strategies by family physicians may be suboptimal.
general practice, primary care, dizziness, vertigo, mortality, prognosis
100-109
van Vugt, Vincent
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van der Wouden, Johannes
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Dros, Jacquelien
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van Weert, Henk C.P.M.
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Yardley, Lucy
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Twisk, Jos
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van der Horst, Henrietta
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Maarsingh, Otto
7ba29f1d-490e-4b95-8e02-55e2ee2aea82
1 March 2020
van Vugt, Vincent
b9f7ffd6-4e63-4751-be79-385af2f5fcaf
van der Wouden, Johannes
f031bfa1-1f52-4cc0-805f-e9ab9908ded7
Dros, Jacquelien
c6a9b9d3-0b70-49fc-95e4-854b44739ae4
van Weert, Henk C.P.M.
21c7f70c-1a18-42f0-839e-8a00eb5db2e1
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Twisk, Jos
9dc532fa-8bf2-44a0-b0f9-a73ecaf2bcf5
van der Horst, Henrietta
4947323c-2c73-4c45-9bea-85866c6f1867
Maarsingh, Otto
7ba29f1d-490e-4b95-8e02-55e2ee2aea82
van Vugt, Vincent, van der Wouden, Johannes, Dros, Jacquelien, van Weert, Henk C.P.M., Yardley, Lucy, Twisk, Jos, van der Horst, Henrietta and Maarsingh, Otto
(2020)
Prognosis and survival of older dizzy patients in primary care: a 10-year prospective cohort study.
Annals of Family Medicine, 18 (2), .
(doi:10.1370/afm.2478).
Abstract
PURPOSE The prognosis of older patients with dizziness in primary care is unknown. Our objective was to determine the prognosis and survival of patients with different subtypes and causes of dizziness. METHODS In a primary care prospective cohort study, 417 older adults with dizziness (mean age 79 years) received a full diagnostic workup in 2006-2008. A panel of physicians classified the subtype and primary cause of dizziness. Main outcome measures were mortality and dizziness-related impairment assessed at 10-year follow-up. RESULTS At 10-year follow-up 169 patients (40.5%) had died. Presyncope was the most common dizziness subtype (69.1%), followed by vertigo (41.0%), dis-equilibrium (39.8%), and other dizziness (1.7%). The most common primary causes of dizziness were cardiovascular disease (56.8%) and peripheral vestibular disease (14.4%). Multivariable adjusted Cox models showed a lower mortality rate for patients with the subtype vertigo compared with other subtypes (hazard ratio [HR] = 0.62; 95% CI, 0.40-0.96), and for peripheral vestibular disease vs cardiovascular disease as primary cause of dizziness (HR = 0.46; 95% CI, 0.25-0.84). After 10 years, 47.7% of patients who filled out the follow-up measurement experienced substantial dizziness-related impairment. No significant difference in substantial impairment was seen between different subtypes and primary causes of dizziness. CONCLUSIONS The 10-year mortality rate was lower for the dizziness subtype vertigo compared with other subtypes. Patients with dizziness primarily caused by peripheral vestibular disease had a lower mortality rate than patients with cardiovascular disease. Substantial dizziness-related impairment in older patients with dizziness 10 years later is high, and indicates that current treatment strategies by family physicians may be suboptimal.
Text
2019.07.09 Prognosis and survival of older dizzy patients in primary care (clean)
- Accepted Manuscript
More information
Accepted/In Press date: 19 July 2019
e-pub ahead of print date: 19 December 2019
Published date: 1 March 2020
Additional Information:
Funding Information:
This study was funded by an Amsterdam Public Health Aging And Later Life innovation grant and by the Netherlands Organisation for Health Research and Development (ZonMW, No. 4200.0018), The Hague. The sponsors did not participate in the study design, data collection, analysis, interpretation, or the preparation or submission of this report.
Publisher Copyright:
© 2020, Annals of Family Medicine, Inc. All rights reserved.
Keywords:
general practice, primary care, dizziness, vertigo, mortality, prognosis
Identifiers
Local EPrints ID: 438314
URI: http://eprints.soton.ac.uk/id/eprint/438314
ISSN: 1544-1709
PURE UUID: 72824eef-08f3-439a-a5a8-1ec700629764
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Date deposited: 04 Mar 2020 17:34
Last modified: 17 Mar 2024 05:22
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Contributors
Author:
Vincent van Vugt
Author:
Johannes van der Wouden
Author:
Jacquelien Dros
Author:
Henk C.P.M. van Weert
Author:
Jos Twisk
Author:
Henrietta van der Horst
Author:
Otto Maarsingh
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