Prognostic value of first-recorded breathlessness for future chronic respiratory and heart disease: a cohort study using a UK national primary care database.
asthma
dyspnoea
electronic health records
general practice
heart disease
respiratory disease
Journal
The British journal of general practice : the journal of the Royal College of General Practitioners
ISSN: 1478-5242
Titre abrégé: Br J Gen Pract
Pays: England
ID NLM: 9005323
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
18
04
2019
accepted:
21
06
2019
pubmed:
12
2
2020
medline:
23
1
2021
entrez:
12
2
2020
Statut:
epublish
Résumé
Breathlessness is a common presentation in primary care. 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. Matched cohort study using data from the UK Clinical Practice Research Datalink. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32041768
pii: bjgp20X708221
doi: 10.3399/bjgp20X708221
pmc: PMC7015162
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e264-e273Informations de copyright
© British Journal of General Practice 2020.
Références
Lancet Respir Med. 2015 Sep;3(9):719-728
pubmed: 26255108
Arch Intern Med. 2006 Nov 13;166(20):2237-43
pubmed: 17101942
BMJ Open. 2014 Jul 23;4(7):e005540
pubmed: 25056980
Lancet Respir Med. 2014 Apr;2(4):267-76
pubmed: 24717623
BMJ. 2014 May 13;348:g3009
pubmed: 24919052
Age Ageing. 2012 Jul;41(4):545-9
pubmed: 22522776
Br J Gen Pract. 2006 Sep;56(530):652-4
pubmed: 16953994
Proc AMIA Annu Fall Symp. 1996;:75-9
pubmed: 8947631
Blood. 2017 Apr 13;129(15):2111-2119
pubmed: 28126928
BMJ Open. 2015 Jun 12;5(6):e007355
pubmed: 26070795
Chest. 2005 May;127(5):1544-52
pubmed: 15888826
Respir Med. 2007 Nov;101(11):2289-96
pubmed: 17681463
Am J Respir Crit Care Med. 2002 Aug 1;166(3):329-32
pubmed: 12153965
Int J Epidemiol. 2015 Jun;44(3):827-36
pubmed: 26050254
Fam Pract. 2013 Apr;30(2):172-8
pubmed: 23045354
Resuscitation. 2014 Jul;85(7):864-8
pubmed: 24704140
Thorax. 2009 Aug;64(8):728-35
pubmed: 19638566
Br J Gen Pract. 2010 Mar;60(572):e128-36
pubmed: 20202356
Chest. 2006 Apr;129(4):879-85
pubmed: 16608933
Lancet. 2013 Jan 12;381(9861):133-41
pubmed: 23107252
Am J Med. 2017 Jun;130(6):756
pubmed: 28449849
Rheumatology (Oxford). 2013 Mar;52(3):452-9
pubmed: 22949726
Thorax. 2006 Nov;61(11):935-9
pubmed: 17071833
Lancet Infect Dis. 2017 May;17(5):e144-e158
pubmed: 28291722
Br J Clin Pharmacol. 2010 Jan;69(1):4-14
pubmed: 20078607