Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam, The Netherlands.
Ann Fam Med. 2020 Mar;18(2):100-109. doi: 10.1370/afm.2478.
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.
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.
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.
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.
基层医疗中老年头晕患者的预后情况尚不清楚。本研究旨在确定不同头晕亚型和病因患者的预后和生存率。
在一项基层医疗前瞻性队列研究中，2006-2008 年共纳入 417 例头晕的老年患者（平均年龄 79 岁），并对其进行了全面的诊断性检查。一组医生对头晕的亚型和主要病因进行了分类。主要结局指标为 10 年随访时的死亡率和头晕相关的功能障碍。
在 10 年随访时，169 例患者（40.5%）死亡。晕厥是最常见的头晕亚型（69.1%），其次是眩晕（41.0%）、不平衡（39.8%）和其他头晕（1.7%）。头晕的最常见主要病因是心血管疾病（56.8%）和外周前庭疾病（14.4%）。多变量调整的 Cox 模型显示，与其他亚型相比，眩晕亚型的死亡率较低（风险比 [HR] = 0.62；95%CI，0.40-0.96），外周前庭疾病作为头晕的主要病因的死亡率也较低（HR = 0.46；95%CI，0.25-0.84）。10 年后，47.7%填写了随访测量的患者出现了明显的头晕相关功能障碍。不同头晕亚型和主要病因之间，在显著功能障碍方面无明显差异。
与其他亚型相比，眩晕亚型的 10 年死亡率较低。外周前庭疾病引起的头晕患者的死亡率低于心血管疾病引起的头晕患者。10 年后，老年头晕患者仍存在较高的头晕相关严重功能障碍，表明家庭医生目前的治疗策略可能并不理想。
