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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
Prognosis and survival of older dizzy patients in primary care: a 10-year prospective cohort study
Purpose: The prognosis of dizzy older patients 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 75.5 years) received a full diagnostic workup in 2006-2008. A panel of physicians classified their dizziness subtype and primary cause of dizziness. Presyncope was the most common dizziness subtype (69.1%), followed by vertigo (41.0%), disequilibrium (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%). 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. Multivariable adjusted Cox models showed a lower mortality rate for patients with the subtype vertigo compared to other subtypes (HR 0.62 (95% CI 0.40 to 0.96)), and for peripheral vestibular disease versus cardiovascular disease as primary cause of dizziness (HR 0.46 (95% CI 0.25 to 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 to 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 dizzy patients 10 years later is high, and indicates that current treatment strategies by FPs may be suboptimal.
general practice, primary care, dizziness, vertigo, mortality, prognosis
1544-1709
100-109
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
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, 100-109. (doi:10.1370/afm.2478).

Record type: Article

Abstract

Purpose: The prognosis of dizzy older patients 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 75.5 years) received a full diagnostic workup in 2006-2008. A panel of physicians classified their dizziness subtype and primary cause of dizziness. Presyncope was the most common dizziness subtype (69.1%), followed by vertigo (41.0%), disequilibrium (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%). 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. Multivariable adjusted Cox models showed a lower mortality rate for patients with the subtype vertigo compared to other subtypes (HR 0.62 (95% CI 0.40 to 0.96)), and for peripheral vestibular disease versus cardiovascular disease as primary cause of dizziness (HR 0.46 (95% CI 0.25 to 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 to 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 dizzy patients 10 years later is high, and indicates that current treatment strategies by FPs may be suboptimal.

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2019.07.09 Prognosis and survival of older dizzy patients in primary care (clean) - Accepted Manuscript
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Accepted/In Press date: 19 July 2019
e-pub ahead of print date: 19 December 2019
Published date: March 2020
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
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 04 Mar 2020 17:34
Last modified: 19 Jun 2020 04:01

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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: Lucy Yardley ORCID iD
Author: Jos Twisk
Author: Henrietta van der Horst
Author: Otto Maarsingh

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