Introduction

Breathlessness is a prevalent symptom in clinical practice with growing incidence. Three-fourths of Australians with breathlessness present to primary care in the past year.

Aims

Understand current patterns of breathlessness care to develop optimized primary care clinical pathways for timely diagnosis of breathlessness associated conditions.

Methods

This cohort study utilized the MedicineInsight primary care database of longitudinally collected de-identified electronic health records of over 5 million patients from 405 GP sites in Australia between January 2014 to November 2021. The geographic distribution of practice sites was similar to that of Australia.

Results

During the study period, 98,889 patients (1.9%) had at least 1 visit with breathlessness as the reason for encounter. In over 80% of patients, at least one of these 10 conditions were diagnosed ? lower respiratory tract infection, asthma, anxiety, depression, coronary heart disease, COPD, heart failure, atrial fibrillation, lung cancer, and pulmonary embolism. Blood tests remain the main diagnostic of choice. Twenty-five percent of patients had a spirometry recorded with 41% with COPD and 34% with asthma having a prior spirometry. A clinical pathway was developed to identify patients as having one or combinations of these major causes, or for neither of them.

Conclusion

A relatively limited number of diseases are diagnosed in most patients presenting with breathlessness in primary care. This made developing clinical pathways that cover the majority of patients with breathlessness feasible to undertake. Further studies are needed to validate the pathway's diagnostic capacity.