Short and Long-Term Prognosis of Hospitalization for Dyspnea Based on Etiology and Hospitalization Ward: Insights from the PARADISE Cohort

Background Dyspnea accounts for nearly 5% of emergency department (ED) visits. Our aim was to describe the in-hospital and long-term outcomes of patients admitted to the ED for dyspnea, based on their underlying etiology, and to determine if prognosis varies according to the hospitalization setting. Methods We analyzed 18,903 consecutive patients (48% male, average age 73 years) hospitalized after an ED visit for dyspnea from January 2010 to December 2019, as part of the PARADISE cohort (PAthwAy of Dyspneic patIent in Emergency - NCT02800122). Dyspnea causes were classified as acute heart failure (AHF), respiratory infection (RI), chronic obstructive pulmonary disease (COPD), pulmonary embolism (PE), or asthma. Results RI (30%), AHF (28%), and COPD (13%) were the predominant discharge diagnoses. In-hospital mortality stood at 12% overall, ranging from 1.1% in asthma to 15% in AHF and RI. Five-year all-cause mortality for patients discharged alive was 75% in AHF, 66% in RI, 62% in COPD, 37% in PE, and 26% in asthma. Hospitalization in specialized wards was associated with significantly reduced in-hospital mortality across all etiologies, and with a decreased long-term mortality for RI and AHF (adjusted-HR 0.90, 95% CI 0.82-0.99, p=0.02 for RI and adjusted-HR 0.90, 95% CI 0.82-0.99, p=0.03 for AHF). Conclusion Patients hospitalized for dyspnea face a high risk of mortality both in-hospital and post-discharge. In view of the strikingly high mortality in dyspneic patients and the potential benefits of specialized management, our study calls for rapidly setting up personalized in-hospital and post-discharge dyspnea pathways.