Causes and health outcomes of breathless patients admitted to hospital in Malawi: a multicentre prospective cohort study

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Introduction: Breathlessness is a common cause of hospital admission globally and associated with high mortality, particularly in low-income countries. In Africa there is a paucity of data on the causes of breathlessness, where existing research has focused on individual diseases. Symptom-based research is needed to address the growing burden from multiple contributing conditions. Aims: The aims of this multicentre prospective study in Malawi were to evaluate causes of breathlessness and health outcomes. Methods: We consecutively recruited breathless adults (≥18 years) within 24-hours of hospitalisation. Patients were systematically screened using internationally accepted diagnostic criteria. We measured disease prevalence, survival and functional outcomes up to one-year post-admission. Results: Among 316 participants, one year outcome status was available for 97% (n=307); 51% (157/307) died within one year. The most common diagnoses were pneumonia (41%; n=131), anaemia (40%; n=126), heart failure (35%; n=112), and tuberculosis (29%; n=91). Two or more concurrent conditions were identified in 63% (n=199). Mortality was highest in patients with heart failure (69%; 75/109; 1y), anaemia (57%; 70/122), pneumonia (53%; 68/129) and tuberculosis (47%; 41/87), and was significantly worse when multiple conditions coexisted. Conclusions: Breathlessness is associated with high mortality in Malawi and two-thirds of breathless patients have more than one concurrent diagnosis. Health systems that focus on single diseases are likely to under-treat many breathless patients. We recommend integrated care interventions with symptom-based diagnostic and treatment strategies to improve outcomes.

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