Breathlessness linked to higher mortality in Malawian hospital patients

Research led by Liverpool School of Tropical Medicine and the Malawi-Liverpool-Wellcome Programme shows that over half of hospital patients with breathlessness had died within a year of admission (51%), as opposed to just 26% of those without the symptom.

Most of these patients had more than one condition that cause breathlessness, including pneumonia, anaemia, heart failure and TB.

The findings demonstrate the importance of integrated, patient-centred care, researchers say, to tackle the burden of high mortality for people with breathlessness, particularly in low-income countries.

Dr. Stephen Spencer, Wellcome Trust Clinical PhD Fellow at Liverpool School of Tropical Medicine (LSTM) and the Malawi-Liverpool-Wellcome Programme (MLW) is lead author on the paper, he said: “Since 2020, the COVID-19 pandemic has energised healthcare communities in Africa to expand oxygen access to hospitals, which is critical for patient care. Sadly, our study shows that breathless patients in Malawi still suffer from mortality rates twice as high as in Europe, despite the younger population in Africa.

“Most of these patients live with more than one condition at the same time, which we found to be a factor linked to higher mortality, such as those with TB or pneumonia. This suggests that treating diseases in isolation is not enough, and healthcare models that have traditionally focused on single presenting conditions may overlook important concurrent diseases. Patient-centred health care interventions that can diagnose and treat multiple illnesses at the same time are urgently needed and should be evaluated to see if they can sustainably reduce mortality.”

Study

Published in Thorax, researchers tracked 751 Malawian hospital patients over 12 months, of whom 334 (44%) had breathlessness as a symptom.

Of these patients, 69% who had heart failure had died within a year, alongside 57% with anaemia, 53% with pneumonia, and 47% with TB. Most patients (63%) had multiple conditions, a factor associated with increased mortality.

Dr Ben Morton, Senior Clinical Lecturer at LSTM and senior author on the paper, said: “This is an important study as it provides robust evidence on the complexity of patients with breathlessness in Southern Africa. Whilst established vertical programmes have been important to improve the management of individual diseases like TB, this study shows that more holistic approaches are required to effectively diagnose and manage patients in this context. We also show that breathlessness is a common reason for hospital presentation with particularly poor outcomes, highlighting the urgency to develop improved programmes of care.”

While the findings from the breathlessness study are alarming and associated with poor patient outcomes, they provide the much-needed evidence and opportunity for Malawi and other resource limited settings to build respiratory support for their health systems. Availability of medical oxygen and increased capacity of healthcare professionals to diagnose and treat breathlessness and multimorbidity are essential to improving quality of care and patient outcomes.”

Dr. Felix Limbani, Co-Investigator, and Senior Research Associate at MLW

The study involved researchers from the Malawi Liverpool Wellcome Programme and Kamuzu University of Health Sciences in Malawi; Kilimanjaro Christian Medical Centre in Tanzania and Muhimbili University of Health and Allied Sciences in Tanzania; Royal United Hospitals Bath NHS Foundation Trust; Liverpool John Moores University; and the University of Manchester and the University of Edinburgh.