An Observational Study of Dyspnea in Emergency Departments: The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study ( AANZDEM )

Objectives The objective was to describe the epidemiology of dyspnea presenting to emergency departments ( ED s) in the Asia‐Pacific region, to understand how it is investigated and treated and its outcome. Methods Prospective interrupted time series cohort study conducted at three time points in ED s in Australia, New Zealand, Singapore, Hong Kong, and Malaysia of adult patients presenting to the ED with dyspnea as a main symptom. Data were collected over three 72‐hour periods and included demographics, comorbidities, mode of arrival, usual medications, prehospital treatment, initial assessment, ED investigations, treatment in the ED , ED diagnosis, disposition from ED , in‐hospital outcome, and final hospital diagnosis. The primary outcomes of interest are the epidemiology, investigation, treatment, and outcome of patients presenting to ED with dyspnea. Results A total of 3,044 patients were studied. Patients with dyspnea made up 5.2% (3,105/60,059, 95% confidence interval [ CI ] = 5.0% to 5.4%) of ED presentations, 11.4% of ward admissions (1,956/17,184, 95% CI  = 10.9% to 11.9%), and 19.9% of intensive care unit ( ICU ) admissions (104/523, 95% CI  = 16.7% to 23.5%). The most common diagnoses were lower respiratory tract infection (20.2%), heart failure (14.9%), chronic obstructive pulmonary disease (13.6%), and asthma (12.7%). Hospital ward admission was required for 64% of patients (95% CI  = 62% to 66%) with 3.3% (95% CI  = 2.8% to 4.1%) requiring ICU admission. In‐hospital mortality was 6% (95% CI  = 5.0% to 7.2%). Conclusion Dyspnea is a common symptom in ED patients contributing substantially to ED , hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.