Epidemiology and outcome of older patients presenting with dyspnoea to emergency departments

Kelly AM 1 , Keijzers G 2 , Klim S 3 , Craig S 4 , Kuan WS 5 , Holdgate A 6 Show all authors , Graham CA 7 , Jones P 8 , Laribi S 9

Affiliations 

  • 1 Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine Australia and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, St Albans, VLC, Parkville, Australia
  • 2 Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia and School of Medicine, Bond University, Gold Coast, QLD, Australia and School of Medicine, Griffith University, Gold Coast, QLD, Australia
  • 3 Joseph Centre for Emergency Medicine Research @ Western Health, Sunshine, Australia and The University of Melbourne, Parkville, Australia
  • 4 Emergency Department, Monash Medical Centre, Clayton, Australia; School of Clinical Sciences, Monash University, Clayton, Australia and Murdoch Children's Research Institute, Parkville, Australia
  • 5 Emergency Medicine Department, National University Health System, Singapore and Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore
  • 6 Department of Emergency Medicine, Liverpool Hospital, Sydney, Australia and University of New South Wales (Southwest Clinical School), Sydney, Australia
  • 7 Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
  • 8 Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand
  • 9 Emergency Medicine Department, Tours University Hospital, 37044 Tours, France
Age Ageing, 2021 01 08;50(1):252-257.
PMID: 32997140 DOI: 10.1093/ageing/afaa121

Abstract

OBJECTIVES: To describe the epidemiology and outcomes of non-traumatic dyspnoea in patients aged 75 years or older presenting to emergency departments (EDs) in the Asia-Pacific region.

METHODS: A substudy of a prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia of patients presenting to the ED with dyspnoea as a main symptom. Data were collected over three 72-h periods and included demographics, co-morbidities, mode of arrival, usual medications, ED investigations and treatment, ED diagnosis and disposition, and outcome. The primary outcomes of interest are the epidemiology and outcome of patients aged 75 years or older presenting to the ED with dyspnoea.

RESULTS: 1097 patients were included. Older patients with dyspnoea made up 1.8% [95% confidence interval (CI) 1.7-1.9%] of ED presentations. The most common diagnoses were heart failure (25.3%), lower respiratory tract infection (25.2%) and chronic obstructive pulmonary disease (17.6%). Hospital ward admission was required for 82.6% (95% CI 80.2-84.7%), with 2.5% (95% CI 1.7-3.6%) requiring intensive care unit (ICU) admission. In-hospital mortality was 7.9% (95% CI 6.3-9.7%). Median length of stay was 5 days (interquartile range 2-8 days).

CONCLUSION: Older patients with dyspnoea make up a significant proportion of ED case load, and have a high admission rate and significant mortality. Exacerbations or worsening of pre-existing chronic disease account for a large proportion of cases which may be amenable to improved chronic disease management.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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