Key result
In heart failure patients, depression increased 3-month all-cause hospitalisation risk by up to 46%, ankle swelling raised 6-month mortality risk by 49%, and shortness of breath increased HF hospitali
Why the study?
To examine associations between symptoms recorded in primary care before and after heart failure diagnosis and short-term hospitalisation and mortality.
Do specific symptoms reported before and after heart failure diagnosis predict 3-month hospitalisation and mortality in adults with incident heart failure?
Do specific symptoms reported before and after heart failure diagnosis predict 3-month hospitalisation and mortality in adults with incident heart failure?
Specific symptoms such as depression, ankle swelling, and shortness of breath reported at and after heart failure diagnosis are significant predictors of short-term hospitalization and mortality.
Symptom assessment may refine short-term risk prediction in new HF; leaves open whether targeting symptoms improves outcomes.
Background We investigated symptoms reported before and after heart failure (HF) diagnosis and their associations with 3-month hospitalisation and mortality. Objectives To examine associations between symptoms recorded in primary care and short-term hospitalisation and mortality in HF patients. Design Landmark analysis using Royston-Parmar survival models at baseline (diagnosis), 6 and 12 months post-diagnosis. Setting Primary care database (Clinical Practice Research Datalink) linked to hospital and mortality data (1998–2020). Participants Adults (>40 years) with a first HF diagnosis. Exposures Shortness of breath, ankle swelling, oedema, fatigue, chest pain, depression and anxiety in the 3 months before diagnosis and at 6 and 12 months. Outcomes 3-month all-cause hospitalisation and mortality; secondary outcomes included HF and non-cardiovascular hospitalisation. Results Among 86 882 HF patients (62 742 and 54 555 surviving to 6 and 12 months, respectively), the magnitude of symptom risk varied by timepoint. Specifically, the symptoms with the strongest associations with adverse outcomes were: depression for all-cause hospitalisation at diagnosis (HR: 1.26; 95% CI 1.15 to 1.39) and 6 months (1.46; 1.25 to 1.70); ankle swelling for mortality (1.49; 1.14 to 1.94) at 6 months and SOB for HF hospitalisation (1.18; 1.12 to 1.26) at diagnosis and 12 months (1.99; 1.68 to 2.35). Conclusions Symptoms persisted and were more prominent at 6 and 12 months post-diagnosis than at diagnosis.
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Ali et al. (2026) studied this question. In heart failure patients, depression increased 3-month all-cause hospitalisation risk by up to 46%, ankle swelling raised 6-month mortality risk by 49%, and shortness of breath increased HF hospitali.
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