Breathlessness recorded in general practice is associated with longer subsequent unplanned hospital admissions: a United Kingdom cohort study.

Background and ObjectiveBreathlessness is associated with higher rates of health service utilisation. We aimed to describe any associations between the severity of breathlessness limiting exertion and the first subsequent inpatient length of stay for unplanned hospital admissions. Methods A retrospective cohort study of adults identified in general practice (United Kingdom (UK) Clinical Practice Research Datalink) with breathlessness (Medical Research Council breathlessness scale; 1-5; 5 the most intense breathlessness limiting exertion; hereafter breathlessness), no pre-existing cardio-respiratory disease and a subsequent unplanned hospital admission. Data 2007-2017 were used. Length of hospital stay stay and time to first unplanned admission were evaluated by intensity of breathlessness, the former using negative binomial regression for the first subsequent unplanned hospital admission, controlling for key demographic factors.Results 103,917 adults were included with a first-recorded breathlessness score, of which 16,948 adults were coded using MRC. 11,911 (70%) adults had a subsequent unplanned hospital admission (median [IQR] 1,538 days [846 – 2,258]). More intesnse breathlessness was associated with higher mean age, higher mean BMI and the proportion of smokers or ex-smokers compared with life-long non-smokers. Negative binomial regression showed an association between higher MRC scores, older age, and a diagnosis at or prior to admission and an increased length of inpatient stay (p<0.001) (AIC = 20,817). Conclusion This is the first study to identify an association between longer unplanned inpatient length of stay and higher pre-hospital MRC breathlessness scale scores from prospectively collected linked data.