Time to diagnosis and long-term outcomes for adults presenting with breathlessness

The impact of delays to diagnosis for individuals presenting with chronic breathlessness is unknown. We investigated the time to diagnosis after presenting with chronic breathlessness and associations with future unplanned hospitalisation and mortality.

A retrospective cohort study using the UK Clinical Practice Research Datalink involving adults with a first recorded code for breathlessness and no pre-existing cardiorespiratory disease. Adjusted Cox regression was used to investigate the associations with unplanned hospitalisation and mortality during all follow-up and within 2 years after the first code of breathlessness between those with and without a diagnosis, and using landmark analysis for time to diagnosis.

66 909/101 369 (66%) of adults with a first recorded code for breathlessness received an explanatory diagnosis during a median 5 years of follow-up. 43 394 (43%) of adults received an explanatory diagnosis within 2 years and had a higher risk (HR (95% CI)) of unplanned hospitalisation (1.25, 1.19 to 1.31) and mortality (1.84, 1.42 to 2.38) in the subsequent 2 years compared with adults without a diagnosis. In those with a recorded diagnosis, waiting ≥6 months was associated with increased mortality (6-24 months: 3.33 (2.13 to 5.20); ≥24 months: 13.30 (8.98 to 19.80)).

We describe better outcomes in adults coded for breathlessness without subsequent explanatory diagnoses. In adults with an explanatory diagnosis, waiting ≥6 months for a diagnosis was associated with reduced survival. Diagnostic pathways for chronic breathlessness need to differentiate between these two groups and achieve earlier diagnosis in those at higher risk.