CVD tied to highest mortality rate vs. other causes of dizziness

Vincent A. van Vugt

Patients with CVD-related dizziness had a higher mortality rate than those whose dizziness was primarily caused by peripheral vestibular disease, according to a prospective cohort study published in Annals of Family Medicine.

Researchers also found that dizziness-related impairment in older patients was common 10 years after their diagnosis.

The first finding is “novel because this is the first study on differences of mortality in dizziness,” Vincent A. van Vugt, MD, from the department of general practice and elderly care medicine at Amsterdam Public Health in the Netherlands, told Healio Primary Care.

Researchers conducted full diagnostic workups on 417 older adults (mean age, 79 years) with dizziness for at least 2 weeks between 2006 and 2008. Ten years later, researchers administered Dizziness Handicap Inventory questionnaires. Each study participant was “definitively categorized” into one or more of the dizziness subtypes — presyncope, vertigo, disequilibrium or other subtype of dizziness — by a majority vote of health care professionals.

Van Vugt and colleagues found that at the 10-year follow-up, presyncope was the most common dizziness subtype (69.1%), followed by vertigo (41%) and disequilibrium (39.8%). In the 169 patients who died before follow-up, CVD was the most common cause of death (56.8%), followed by peripheral vestibular disease (14.4%). Adjusted analyses showed a lower mortality rate for patients with vertigo vs. other subtypes (HR = 0.62; 95% CI, 0.4-0.96) and for peripheral vestibular disease vs. CVD as the primary cause of dizziness (HR = 0.46; 95% CI, 0.25-0.84). The mean Dizziness Handicap Inventory score among the 47.7% of patients who completed the questionnaire at the 10-year follow-up was 31.1 — exceeding the 30-point mark indicative of substantial dizziness-related impairment.

One of the study’s co-authors, Otto Maarsingh MD, PhD, of the department of general practice and elderly care medicine at Amsterdam Public Health in the Netherlands, recently published suggestions on maximizing treatment for older patients with dizziness in the Journal of the American Medical Directors Association. These tips included:

identifying dysfunctional elements of the overall balance system that can be improved with treatment;

applying an organized and systematic diagnosis-oriented approach to ascertaining all the dizziness’ contributing factors, with a focus on those that are amenable to treatment, such as anxiety, depression, impaired mobility and polypharmacy;

• taking a thorough medical history by asking questions such as the duration of the patient’s dizziness, as well as its duration, onset, frequency, provoking circumstances;
• exploring possible causes of dizziness, such as CV, locomotor, metabolic, neurologic, psychiatric, visual and vestibular disease;
• conducting a medication review and consider prescribing alternatives for medications known to cause dizziness;
• recognizing that a multifactorial source of the dizziness will often be identified, which will necessitate a multifactorial treatment plan; and
• setting intervention priorities based on the state of the evidence for the type of dizziness that was diagnosed.

“Hopefully [these tips] can lower long-term early mortality and dizziness-related impairment,” van Vugt said. – by Janel Miller

References:

Sloane PD, et al. J Am Med Dir Assoc. 2020;doi:10.1016/j.jamda.2020.01.105.

van Nugt VA, et al. Ann Fam Med. 2020;doi:10.1370/afm.2478.

Disclosures: The authors report no relevant financial disclosures.