According to research published in ERJ Open Research, hospital patients who are short of breath are six times more likely to die compared to patients who were in pain. The study, “Patient-Reported Dyspnea Predicts 6-fold Hospital Mortality,” is the first of its kind.
Robert Banzett, PhD, who led the study, said the data suggest that prompting patients to report feeling short of breath could help health care professionals to prioritize patients who need care most. Dr. Banzett is associate professor at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
“The sensation of dyspnea, or breathing discomfort, is a really unpleasant symptom. Some people experience it as feeling starved for air or suffocated,” Dr. Banzett, said in an European Respiratory Society (ERS) press release. “In hospital, nurses routinely ask patients to rate any pain they are experiencing, but this is not the case for dyspnea. In the past, our research has shown that most people are good at judging and reporting this symptom, but there is very little evidence on whether it’s linked to how ill hospital patients are.”
In the study, nurses at Beth Israel asked patients to self-report shortness of breath twice a day on a scale of zero to 10 — the same way patients are asked to self-report pain. Researchers examined the patient-rated shortness of breath and pain scores of 9,785 adults who were admitted to the hospital between March 2014 and September 2016.
They compared these results with clinical outcomes data, including deaths, over the next two years. The analysis revealed that patients who developed shortness of breath were six times more likely to die than patients who did not develop it. Patients who rated their shortness of breath higher on the scale were at an increased risk of dying.
“It is important to note that dyspnea is not a death sentence — even in the highest risk groups, 94% of patients survive hospitalization, and 70% survive at least two years following hospitalization,” Dr. Banzett said. “But knowing which patients are at risk with a simple, fast and inexpensive assessment should allow better individualized care. We believe that routinely asking patients to rate their shortness of breath will lead to better management of this often-frightening symptom.”
The data also showed that patients with shortness of breath were more likely to require care from a rapid response team and be transferred to an intensive care unit. Researchers did not find a clear association between patient-reported pain scores and risk of dying.
“This study highlights how a simple dyspnea rating can serve as a strong, early warning sign of clinical decline,” said Cláudia Almeida Vicente, MD, chair of the ERS’s general practice and primary care group in Portugal. “New-onset breathlessness during hospitalization carried especially high risk, far exceeding that associated with pain. … From a primary care perspective, the elevated two-year mortality in patients discharged with dyspnea signals the need for tighter post-hospital follow-up.”
Dr. Banzett said the study results need further validation in other hospitals and regions. He also said he hopes this research prompts a closer look at whether patient-reported shortness of breath leads to better treatments and outcomes.
“These noteworthy findings should trigger more research to understand the mechanisms underpinning this association and how this ‘powerful alarm’ can be harnessed to improve patient care,” said Hilary Pinnock, MD, chair of the ERS’s education council and professor at the University of Edinburgh.
