Chronic breathlessness is associated with much longer lengths of hospital stay

There are wide variations in acute care inpatient lengths of stay. Until now, analysing these variations included patient, clinical and system factors, leaving 40–80% of the variation still unexplained. Chronic breathlessness has been ignored by health systems: the first international consensus definition was only proposed in 2017, and the first International Classification of Disease (ICD) code for it was accepted in 2022. (Until 2022, the health system through ICD only recognised ‘acute breathlessness’ and ‘orthopnoea’ (the inability to lie flat without breathlessness).) Studies of the general population (independent of health service contact) have shown that at least 1 in 300 Australians are housebound or have difficulty dressing and undressing because of chronic breathlessness. The symptom affects every part of a person’s life and contributes to unplanned use of primary and tertiary healthcare. Rather than focusing only on diseases in understanding variations in length of stay, the addition of chronic symptoms is of value. In recent work, pre-existing breathlessness (captured in general practice) predicts a shorter time to people’s next unplanned hospital admission and longer hospital admissions for every increased level of chronic breathlessness severity, having controlled for other factors. ICD v11.0 now has a code 'chronic breathlessness' that we should be using. Research is needed on why people with chronic breathlessness have increased use of emergency departments and longer lengths of stay. Clinicians need to actively identify the presence of chronic breathlessness, and health systems need to research how to minimise its impacts.