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Breathlessness intensity recorded in general practice is associated with shorter times to unplanned hospital admissions and longer lengths of stay : a UK cohort study

Karsanji, Urvee ; Brunelli, Vanessa N. ; Lawson, Claire A. ; Bottle, Alex ; Ekström, Magnus LU orcid ; Kinchin, Irina ; Kochovska, Slavica ; Ferreira, Diana ; Quint, Jennifer K. and Steiner, Michael C. , et al. (2025) In BMJ Open Respiratory Research 12(1).
Abstract

Background and objective Breathlessness is associated with higher rates of unplanned health service utilisation. We aimed to evaluate any associations between the severity of breathlessness limiting exertion (hereafter breathlessness), time between breathlessness recording and subsequent unplanned hospital admissions, and length of stay. Methods A retrospective cohort study of adults seen in general practice (UK Clinical Practice Research Datalink) with breathlessness (Medical Research Council (MRC) breathlessness scale; 1–5; 5 is most intense), no preexisting cardio-respiratory disease and a subsequent unplanned hospital admission. Data from 2007 to 2017 were used. By intensity of breathlessness, time to first unplanned admission and... (More)

Background and objective Breathlessness is associated with higher rates of unplanned health service utilisation. We aimed to evaluate any associations between the severity of breathlessness limiting exertion (hereafter breathlessness), time between breathlessness recording and subsequent unplanned hospital admissions, and length of stay. Methods A retrospective cohort study of adults seen in general practice (UK Clinical Practice Research Datalink) with breathlessness (Medical Research Council (MRC) breathlessness scale; 1–5; 5 is most intense), no preexisting cardio-respiratory disease and a subsequent unplanned hospital admission. Data from 2007 to 2017 were used. By intensity of breathlessness, time to first unplanned admission and hospital length of stay were evaluated, the latter using negative binomial regression. Results 103 917 adults had breathlessness scores recorded, of which 16 948 used MRC. 11 911 (70%) adults had a subsequent unplanned hospital admission (median (IQR) of 1538 days (846–2258)) later. More intense breathlessness was associated with higher age, higher body mass index and being a smoker/ex-smoker. Length of time between a first-recorded breathlessness score and the first unplanned hospital admission decreased significantly with higher MRC scores (MRC 1: 1167 days; MRC 5: 615 days). Negative binomial regression showed an association between higher MRC scores and an increased length of inpatient stay (p<0.001; Akaike information criterion=20 817), controlling for key demographic factors. Conclusion This is the first study to identify an association between recording breathlessness intensity and time to a person’s first unplanned hospital admission and longer inpatient length of stay. Future work must focus on whether interventions can change people’s health service use.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BMJ Open Respiratory Research
volume
12
issue
1
article number
e003000
publisher
BMJ Publishing Group
external identifiers
  • scopus:105012397197
  • pmid:40738555
ISSN
2052-4439
DOI
10.1136/bmjresp-2024-003000
language
English
LU publication?
yes
additional info
Publisher Copyright: © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.
id
c1f01586-eeb0-46c8-b314-03c593fb2b46
date added to LUP
2025-12-12 11:00:57
date last changed
2026-01-09 14:08:08
@article{c1f01586-eeb0-46c8-b314-03c593fb2b46,
  abstract     = {{<p>Background and objective Breathlessness is associated with higher rates of unplanned health service utilisation. We aimed to evaluate any associations between the severity of breathlessness limiting exertion (hereafter breathlessness), time between breathlessness recording and subsequent unplanned hospital admissions, and length of stay. Methods A retrospective cohort study of adults seen in general practice (UK Clinical Practice Research Datalink) with breathlessness (Medical Research Council (MRC) breathlessness scale; 1–5; 5 is most intense), no preexisting cardio-respiratory disease and a subsequent unplanned hospital admission. Data from 2007 to 2017 were used. By intensity of breathlessness, time to first unplanned admission and hospital length of stay were evaluated, the latter using negative binomial regression. Results 103 917 adults had breathlessness scores recorded, of which 16 948 used MRC. 11 911 (70%) adults had a subsequent unplanned hospital admission (median (IQR) of 1538 days (846–2258)) later. More intense breathlessness was associated with higher age, higher body mass index and being a smoker/ex-smoker. Length of time between a first-recorded breathlessness score and the first unplanned hospital admission decreased significantly with higher MRC scores (MRC 1: 1167 days; MRC 5: 615 days). Negative binomial regression showed an association between higher MRC scores and an increased length of inpatient stay (p&lt;0.001; Akaike information criterion=20 817), controlling for key demographic factors. Conclusion This is the first study to identify an association between recording breathlessness intensity and time to a person’s first unplanned hospital admission and longer inpatient length of stay. Future work must focus on whether interventions can change people’s health service use.</p>}},
  author       = {{Karsanji, Urvee and Brunelli, Vanessa N. and Lawson, Claire A. and Bottle, Alex and Ekström, Magnus and Kinchin, Irina and Kochovska, Slavica and Ferreira, Diana and Quint, Jennifer K. and Steiner, Michael C. and Evans, Rachael A. and Currow, David C.}},
  issn         = {{2052-4439}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{1}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Open Respiratory Research}},
  title        = {{Breathlessness intensity recorded in general practice is associated with shorter times to unplanned hospital admissions and longer lengths of stay : a UK cohort study}},
  url          = {{http://dx.doi.org/10.1136/bmjresp-2024-003000}},
  doi          = {{10.1136/bmjresp-2024-003000}},
  volume       = {{12}},
  year         = {{2025}},
}