# Association of symptoms at heart failure diagnosis with hospitalisation and mortality at 6 and 12 months: a retrospective cohort study using UK primary care health records

## TL;DR

This study found that certain symptoms at heart failure diagnosis, like depression and ankle swelling, are linked to higher hospitalization and mortality risks within 6 to 12 months.

## Contribution

The study introduces new insights into how specific symptoms at diagnosis and follow-up correlate with adverse outcomes in heart failure patients.

## Key findings

- Depression was strongly associated with hospitalization at 6 months post-diagnosis.
- Ankle swelling was linked to increased mortality at 6 months.
- Shortness of breath was associated with heart failure hospitalization at diagnosis and 12 months.

## Abstract

We investigated symptoms reported before and after heart failure (HF) diagnosis and their associations with 3-month hospitalisation and mortality.

To examine associations between symptoms recorded in primary care and short-term hospitalisation and mortality in HF patients.

Landmark analysis using Royston-Parmar survival models at baseline (diagnosis), 6 and 12 months post-diagnosis.

Primary care database (Clinical Practice Research Datalink) linked to hospital and mortality data (1998–2020).

Adults (>40 years) with a first HF diagnosis.

Shortness of breath, ankle swelling, oedema, fatigue, chest pain, depression and anxiety in the 3 months before diagnosis and at 6 and 12 months.

3-month all-cause hospitalisation and mortality; secondary outcomes included HF and non-cardiovascular hospitalisation.

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).

Symptoms persisted and were more prominent at 6 and 12 months post-diagnosis than at diagnosis.