Abnormally high exertional breathlessness predicts mortality in people referred for incremental cycle exercise testing
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Key result
Abnormally high exertional breathlessness during incremental cycle exercise testing was associated with a significantly higher risk of all-cause mortality (aHR 2.3) compared to normal breathlessness.
Why the study?
Exertional breathlessness is a key cardiorespiratory symptom that can be quantified during incremental exercise testing, but its prognostic significance was unknown.
Does abnormally high exertional breathlessness during incremental cycle exercise testing predict mortality in adults referred for clinical exercise testing?
Population
13,506 adults referred for exercise testing
Comparison
Abnormally high exertional breathlessness vs within normal predicted ranges
Design
Longitudinal cohort study
Follow-up
Median 8.0 years
Authors
Discussion
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Member takes
Implication
May identify higher-risk patients on exercise testing; leaves open whether targeting breathlessness improves survival.
Study Design
Type
Cohort (n=13,506)
Multicenter
No
Structured PICO
Does abnormally high exertional breathlessness during incremental cycle exercise testing predict mortality in adults referred for clinical exercise testing?
P
Population
13,506 adults (mean age 59 years, 46% female) referred for incremental cycle exercise testing were followed for a median of 8.0 years to assess mortality.
E
Exposure
Abnormally high exertional breathlessness during incremental cycle exercise testing (defined as a Borg CR10 breathlessness intensity rating > the upper limit of normal using published reference equations).
C
Comparator
Normal exertional breathlessness intensity (Borg CR10 rating ≤ the upper limit of normal).
O
Outcome
All-cause, respiratory, and cardiac mortality assessed using the Swedish National Causes of Death Registry.hard clinical
Main Result
Hazard Ratio: 2.3 (95% CI 2.1–2.6)
p-value: p=<0.001
Abnormally high exertional breathlessness during routine clinical exercise testing is a strong, independent predictor of all-cause, respiratory, and cardiac mortality.
Limitations
- Physiological data were limited, with no access to pulmonary function tests, ventilation, or gas exchange to ensure maximal effort.
- Findings pertain to cycle ergometer exercise and may not be directly applicable to treadmill (weight-bearing) exercise.
- Possible bias from more frequent breathlessness inquiries in highly symptomatic patients.
- Sensitivity for milder diseases like hypertension is lower in the National Patient Register.
- No information on the specific reasons behind abnormally high exertional breathlessness or smoking status.
- Single-center study design.
Cite This Study
Elmberg et al. (2024) conducted a cohort in Referred for incremental cycle exercise testing (n=13,506). Abnormally high exertional breathlessness vs. Normal exertional breathlessness was evaluated on All-cause mortality (aHR 2.3, 95% CI 2.1-2.6, p=<0.001). Abnormally high exertional breathlessness during incremental cycle exercise testing was associated with a significantly higher risk of all-cause mortality (aHR 2.3) compared to normal breathlessness.
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