Patterns of multiple long-term conditions in patients presenting with breathlessness and their associations with adverse outcomes

Patients presenting with breathlessness often have pre-existing diagnoses of multiple long-term conditions (MLTC). We investigated baseline patterns of MLTC and their associations with downstream rates of health service utilisation and risk of mortality in a cohort of patients with a first recorded code for breathlessness. We conducted a retrospective cohort study using the Clinical Practice Research Datalink (CPRD). Adults with a first recorded code for breathlessness were included. Patients with MLTCs (≥ 2 long-term conditions (LTC)) formed the main cohort, while those with ≤ 1 LTC served as controls. Latent class analysis (LCA) identified classes with similar MLTC patterns. Regression models compared two-year health-service utilisation and five-year mortality between MLTC classes and controls. We identified 57,163 patients with MLTCs and 44,206 controls. Thirteen classes of patients with distinct patterns of MLTCs were identified through LCA. The ‘depression-prevalent with co-occurring anxiety and hypertension’ class had the highest relative rates of primary care consultations, while the ‘hypertension-prevalent with co-occurring cerebrovascular disease’ class had the highest relative rates of unplanned hospital admissions, compared with controls. Five-year mortality risk was highest in the ‘learning disability-prevalent with co-occurring epilepsy’ class. Distinct MLTC patterns in adults presenting with breathlessness were associated with variation in healthcare use and mortality. Our results highlight opportunities for improved mechanistic understanding, risk stratification and appropriation of clinical care.