BMJ Open. 2026 Feb 12;16(2):e107490. doi: 10.1136/bmjopen-2025-107490.
ABSTRACT
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.
PMID:41689226 | DOI:10.1136/bmjopen-2025-107490