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. 2020 Mar;18(2):100-109.
doi: 10.1370/afm.2478.

Prognosis and Survival of Older Patients With Dizziness in Primary Care: A 10-Year Prospective Cohort Study

Vincent A van Vugt  1 , Gülsün Bas  2 , Johannes C van der Wouden  2 , Jacquelien Dros  3 , Henk C P M van Weert  3 , Lucy Yardley  4 , Jos W R Twisk  5 , Henriëtte E van der Horst  2 , Otto R Maarsingh  2
Affiliations

Prognosis and Survival of Older Patients With Dizziness in Primary Care: A 10-Year Prospective Cohort Study

Vincent A van Vugt et al. Ann Fam Med. 2020 Mar.

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%), 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%). 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.

Keywords: aged; dizziness; family practice; mortality; vertigo.

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Figures

Figure 1
Figure 1
Kaplan-Meier survival curves for patients assigned to dizziness subtype vertigo.a aPanel assigned subtype by at least 2 out of 3 panel members. Patients with vertigo compared with patients who were not assigned to this subtype.
Figure 1
Figure 1
Kaplan-Meier survival curves for patients assigned to dizziness subtype vertigo.a aPanel assigned subtype by at least 2 out of 3 panel members. Patients with vertigo compared with patients who were not assigned to this subtype.
Figure 2
Figure 2
Kaplan-Meier survival curves for patients with different primary causes of dizziness. aLocomotor disease, neurologic disease (excluding cerebrovascular disease), adverse drug effect, metabolic or endocrine conditions, impaired vision, other causes, and unclear cause.
Figure 2
Figure 2
Kaplan-Meier survival curves for patients with different primary causes of dizziness. aLocomotor disease, neurologic disease (excluding cerebrovascular disease), adverse drug effect, metabolic or endocrine conditions, impaired vision, other causes, and unclear cause.
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