Chen, Y, Hayward, R, Chew-Graham, CA ORCID: https://orcid.org/0000-0002-9722-9981, Hubbard, R, Croft, P, Sims, K and Jordan, KP ORCID: https://orcid.org/0000-0003-4748-5335 (2020) Prognostic value of first-recorded breathlessness for future chronic respiratory and heart disease a cohort study using a UK national primary care database. British Journal of General Practice.

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Abstract

BACKGROUND: Breathlessness is a common presentation in primary care. AIM: To assess the long-term risk of diagnosed chronic obstructive pulmonary disease (COPD), asthma, ischaemic heart disease (IHD), and early mortality in patients with undiagnosed breathlessness. DESIGN AND SETTING: Matched cohort study using data from the UK Clinical Practice Research Datalink. METHOD: Adults with first-recorded breathlessness between 1997 and 2010 and no prior diagnostic or prescription record for IHD or a respiratory disease ('exposed' cohort) were matched to individuals with no record of breathlessness ('unexposed' cohort). Analyses were adjusted for sociodemographic and comorbidity characteristics. RESULTS: In total, 75 698 patients (the exposed cohort) were followed for a median of 6.1 years, and more than one-third subsequently received a diagnosis of COPD, asthma, or IHD. In those who remained undiagnosed after 6 months, there were increased long-term risks of all three diagnoses compared with those in the unexposed cohort. Adjusted hazard ratios for COPD ranged from 8.6 (95% confidence interval [CI] = 6.8 to 11.0) for >6-12 months after the index date to 2.8 (95% CI = 2.6 to 3.0) for >36 months after the index date; asthma, 11.7 (CI = 9.4 to 14.6) to 4.3 (CI = 3.9 to 4.6); and IHD, 3.0 (CI = 2.7 to 3.4) to 1.6 (CI = 1.5 to 1.7). Risk of a longer time to diagnosis remained higher in members of the exposed cohort who had no relevant prescription in the first 6 months; approximately half of all future diagnoses were made for such patients. Risk of early mortality (all cause and disease specific) was higher in members of the exposed cohort. CONCLUSION: Breathlessness can be an indicator of developing COPD, asthma, and IHD, and is associated with early mortality. With careful assessment, appropriate intervention, and proactive follow-up and monitoring, there is the potential to improve identification at first presentation in primary care in those at high risk of future disease who present with this symptom.

Item Type: Article
Additional Information: The final accepted manuscript and relevant information can be found at; https://bjgp.org/content/early/2020/02/10/bjgp20X708221
Uncontrolled Keywords: Prognostic value, breathlessness, respiratory and heart disease.
Subjects: H Social Sciences > H Social Sciences (General)
Q Science > Q Science (General)
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 17 Feb 2020 09:54
Last Modified: 17 Feb 2020 09:54
URI: https://eprints.keele.ac.uk/id/eprint/7649

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