Vertigo Management – Mapping prevalence and treatment. Understanding once a day preparation usage and place in therapy.

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CARDIOLOGISTS

CARDIOLOGISTS(SAMPLE SIZE = 20)
·               The incidence of, 15-25% patients was found to be a majority amongst 40% Cardiologists, who have administered anti-vertigo medications.
·               The % of female patients who seek anti-vertigo medications were found to be on the higher side amongst Cardiologists.
·               55% of the Cardiologists felt that a 40:60 (Male:Female) ratio is most observed in their practice.
·               56.52% Cardiologists reported that 40-50 years was the prevalent category of the patients.
·               Majorly 85% of Cardiologists observed Vertigo patients with Secondary to pre-existing ailment.
·               Diabetes Mellitus is the most common secondary to pre-existing ailment reported by Cardiologists, followed by Hypertension & Cardiac problems (28.13%) amongst the Cardiologists.
·               BPPV is the most common cause of Vertigo, followed by Labyrinthitis and Vestibular Neuronitis amongst the sampled Cardiologists.
·               Pharmacological therapy is the most preferred line of treatment amongst 68.18% Cardiologists for effective Vertigo management.
·               Betahistine is the most preferred drug of choice for treating vertigo amongst 100% Cardiologists.
·               55 % of the Cardiologists prefer to give 8mg TID dose of Betahistine to patients to treat vertigo.
·               1-2 weeks is the most preferred duration of therapy with Betahistine amongst 65% Cardiologists.
·               80% of the Cardiologists were found to titrate the dosage in Vertigo treatment.
·               Majority (80%) of the Cardiologists were found to be aware of Betahistine once a day preparation.
·               70% of the Cardiologists did not use Betahistine O.D formulation, they reportedly used the conventional doses.
·               Amongst all Cardiologists those who use Betahistine once a day preparation, 66.67% mostly prescribe 24mg C.R, while 33.33% use 48mg C.R formulation.
·               The duration for which 24mg C.R is prescribed the most, is equally by 33.33% Cardiologists for 1 week and 2 weeks respectively.
·               60% of the Cardiologists prefer to use O.D formulation as a start up dose, while the rest (40%) preferred to use it as a maintenance dose only.
·               Majority (95%) of the Cardiologists do not use O.D formulation particularly specific to any indication.
·               90% of the Cardiologists do not use two Anti-Vertigo molecules together.
·               45% of the Cardiologists have not tried this combination, but 45% said it to be a potent and viable combination.
·               They were further aided by 5% of doctors who felt it maybe a fruitful combination.

1.      In your practice what is the incidence of patients who need anti-vertigo medication?

Total Respondents = 20

Category

Responses

Percentage of responses

5-10%

5

25

10-15%

5

25

15-25%

8

40

More than 25%

2

10

Table 38: Responses for incidence of patients requiring Anti-Vertigo Medication per week

Interpretation:
·             The incidence of, 15-25% patients was found to be a majority amongst 40% Cardiologists, who have administered anti-vertigo medications.
·             The incidence of 5-10% & 10-15% patients were also reported amongst 25% Cardiologists respectively.
·             Only 10% of the Cardiologists reported of more than 25% patients requiring anti-vertigo medication.

2.      May I know the approximate bifurcation of patients gender wise (in %)?

Total Respondents = 20

% of Patients

Approx Ratio

Responses

% of Responses

Male

40

11

55

Female

60

 

Male

50

5

25

Female

50

       

Male

30

4

20

Female

70

Table 39: Responses for gender bifurcation of patients requiring Anti-Vertigo Medication per week

Interpretation:
·         The % of female patients who seek anti-vertigo medications were found to be on the higher side amongst Cardiologists.
·         55% of the Cardiologists felt that a 40:60 (Male:Female) ratio is most observed in their practice.
·         30:70 (Male:Female) ratio was observed amongst 25% Cardiologists.
·         20% Cardiologists observed an equal ratio of 50:50 (Male:Female) in their practice.

3.      Is it more predominant in any particular age group?

Total Respondents = 20 (Multiple responses)

Age of Patients

Responses

% of Responses

Below 20 years

0

0

20-40 years

0

0

40-50 years

13

56.52

Above 50 years

10

43.48

Table 40: Responses for prevalent age group of patients requiring Anti-Vertigo Medication per week

Interpretation:
·         56.52% Cardiologists reported that 40-50 years was the prevalent category of the patients.
·         Patients above 50 years age was reported with 43.48% Cardiologists, while there were no patients reported below 40 years.

4.      Of these patients reported, do you get most patients as primary vertigo/dizziness patients or it is secondary to some pre-existing ailment?

Total Respondents = 20

Type

Responses

% of Responses

Primary

3

15

Secondary

17

85

Table 41: Responses for category of patient having secondary to pre-existing ailment

Interpretation:
·         It was revealed through the study that only, 15% of the Cardiologists, observed patients with Primary Vertigo.
·         Majorly 85% of Cardiologists observed Vertigo patients with Secondary to pre-existing ailment.

5.      If it is secondary to pre-existing ailment, what is the most common pre-existing disease/disorder you see?

Total Respondents = 17 multiple responses (out of 20 Cardiologists)

Disorder

Responses

% of Responses

Diabetes Mellitus

14

43.75

Hypertension & Cardiac problems

9

28.13

ENT problems

3

9.38

Spondylosis

4

12.5

Thyroid

2

6.25

Table 42: Responses for patents having most common secondary to pre-existing ailment

Interpretation:
·         Diabetes Mellitus (43.75%) is the most common secondary to pre-existing ailment reported by Cardiologists, followed by Hypertension & Cardiac problems (28.13%) amongst the Cardiologists.
·         Spondylosis along with ENT problems were also reported in12.5% & 9.38% Cardiologists respectively.
·         6.25% Cardiologists felt Thyroid could be the secondary to pre-existing cause of Vertigo.

6.      What are the most common causes of Vertigo that you see in your practice?

Cause

Frequency of Ranks

Rank 1

Rank 2

Rank 3

Rank 4

Rank 5

Rank 6

 

BPPV

20

 

 

 

 

 

 

Labyrinthitis

 

12

2

 

 

 

 

Vestibular Neuronitis

 

2

5

1

 

 

 

Spondylosis

 

2

4

2

 

 

 

Meniere’s Disease

 

 

2

1

 

 

Table 43: Table depicting the most common cause of Vertigo as ranked

Total Respondents = 20

Interpretation:
·         BPPV is the most common cause of Vertigo, followed by Labyrinthitis and Vestibular Neuronitis amongst the sampled Cardiologists.
·         Spondylosis & Meniere’s Disease were the other causes reported by the Cardiologists (in decreasing order of occurrence).

7.      What is the usual line of treatment?

Total Respondents = 20 (multiple responses)

Line of Treatment

Responses

% of Responses

Lifestyle modification

0

0

Pharmacological

15

68.18

Manoeuvres only

0

0

Pharmacological and Manoeuvres

7

31.82

Table 44: Responses for usual line of treatment in Vertigo management

Interpretation:
·         Pharmacological therapy is the most preferred line of treatment amongst 68.18% Cardiologists for effective Vertigo management.
·         31.82% Cardiologists also resort to Pharmacological & Manoeuvres therapy for treating Vertigo.
·         Lifestyle Modification and only Manoeuvres were not opted by any Cardiologists.

8.      In pharmacological treatment what is your drug of choice?

Total Respondents = 20 (multiple responses)

Molecule

Responses

% of Responses

Betahistine

20

100

Cinnarizine

0

0

Dimenhydrinate

0

0

Combination

0

0

Any other

0

0

Table 45: Responses for molecule management in Vertigo management pharmacologically

Interpretation:
·         Betahistine is the most preferred drug of choice for treating vertigo amongst 100% Cardiologists.

9.      May I know your usual treatment approach?

 

8 mg

16mg

24mg

24mg C.R

48 mg C.R

OD

--

--

--

--

--

BID

1

3

6

--

--

TID

10

--

--

--

--

Table 46: Chart showing the type of Betahistine dose prescribed for treating Vertigo

Total Respondents = 20

Interpretation:
·         55 % of the Cardiologists prefer to give 8mg TID dose of Betahistine to patients to treat vertigo.
·         30% of the Cardiologists prescribe 24mg BID dosage, while 15% of them prefer 16mg BID, for pharmacological therapy with Betahistine for Vertigo.
·         Only 5% of Cardiologists prescribes 8mg BID for treatment in of Vertigo.
·         Out of all the Cardiologists sampled none were seen to prescribe OD formulation of Betahistine to their patients.

Duration:

Total Respondents = 20                                    

Duration

Responses

 

Table 47: Responses for duration of pharmacological therapy for Vertigo

% of responses

1-2 weeks

13

65

3-4 weeks

7

35

Interpretation:
·         1-2 weeks is the most preferred duration of therapy with Betahistine amongst 65% Cardiologists.
·         35% Cardiologists opted for 3-4 weeks of therapy with Betahistine.

10.  Do you titrate dosage?

Total Respondents = 20

Response to question

Responses

% of Responses

Yes

16

80

No

4

20

Table 48: Responses for dosage titration in treating Vertigo

Interpretation:
·         80% of the Cardiologists were found to titrate the dosage in Vertigo treatment.
·         With the usual approach being tapering down the dosage in patients where symptoms are relieved and do not recur, and then putting it off. But in some recurrent cases of vertigo the dosage was increased.
·         Where as 20% of the Cardiologists did not titrate the dosage.

11.  Doctor, are you aware of once a day Betahistine preparation?

Total Respondents = 20

Response to question

Responses

% of Responses

Yes

16

80

No

4

20

Table 49: Responses for Betahistine O.D awareness

Interpretation:
·         Majority (80%) of the Cardiologists were found to be aware of Betahistine once a day preparation.
·          Only 20% Cardiologists were still unaware of Betahistine O.D formulation.

12.  If Yes, have you used?

Total Respondents = 20

Response to question

Responses

% of Responses

Yes

6

30

No

14

70

Table 50: Responses for Betahistine O.D usage

Interpretation:
·         70% of the Cardiologists did not use Betahistine O.D formulation, they reportedly used the conventional doses.
·         30% of the sampled Cardiologists, were found to use Betahistine O.D formulation.

13.  If answer to Q11 is Yes, what is preferred strength & duration?

Total Respondents = 6 (out of 20 Cardiologists)

Strength

Duration

Responses

% of Responses

Overall %

24 mg

1 week

2

33.33

66.67

2 weeks

2

33.33

4 weeks

0

0

 

48 mg

1 week

1

16.67

33.33

2 weeks

1

16.67

4 weeks

0

0

 

Table 51: Responses for preferred strength of Betahistine O.D usage

Interpretation:
·         Amongst all Cardiologists those who use Betahistine once a day preparation, 66.67% mostly prescribe 24mg C.R, while 33.33% use 48mg C.R formulation.
·         The duration for which 24mg C.R is prescribed the most, is equally by 33.33% Cardiologists for 1 week and 2 weeks respectivey.
·         16.67% Cardiologists use 48mg C.R for 1 week and 2 weeks respectively.

14.  If used, how do you use the OD formulation?

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