Symptoms and signs in patients with heart failure: association with 3-month hospitalisation and mortality

Abstract

ObjectivesTo determine the association between symptoms and signs reported in primary care consultations following a new diagnosis of heart failure (HF), and 3-month hospitalisation and mortality.DesignNested case–control study with density-based sampling.SettingClinical Practice Research Datalink, linked to hospitalisation and mortality (1998–2020).ParticipantsDatabase cohort of 86 882 patients with a new HF diagnosis. In two separate analyses for (1) first hospitalisation and (2) death, we compared the 3-month history of symptoms and signs in cases (patients with HF with the event), with their respective controls (patients with HF without the respective event, matched on diagnosis date (±1 month) and follow-up time). Controls could be included more than once and later become a case.Main outcome measuresAll-cause, HF and non-cardiovascular disease (non-CVD) hospitalisation and mortality.ResultsDuring a median follow-up of 3.22 years (IQR: 0.59–8.18), 56 677 (65%) experienced first hospitalisation and 48 146 (55%) died. These cases were matched to 356 714 and 316 810 HF controls, respectively. For HF hospitalisation, the strongest adjusted associations were for symptoms and signs of fluid overload: pulmonary oedema (adjusted OR 3.08; 95% CI 2.52, 3.64), shortness of breath (2.94; 2.77, 3.11) and peripheral oedema (2.16; 2.00, 2.32). Generic symptoms also showed significant associations: depression (1.50; 1.18, 1.82), anxiety (1.35; 1.06, 1.64) and pain (1.19; 1.10, 1.28). Non-CVD hospitalisation had the strongest associations with chest pain (2.93; 2.77, 3.09), fatigue (1.87; 1.73, 2.01), general pain (1.87; 1.81, 1.93) and depression (1.59; 1.44, 1.74).ConclusionsIn the primary care HF population, routinely recorded cardiac and non-specific symptoms showed differential risk associations with hospitalisation and mortality.

Symptom cluster profiles predict all-cause mortality among older adults with heart failure

“…Non-HF speci c symptoms, such as pain, anxiety, and depressive symptoms, had strong associations with adverse outcomes, such as higher hospitalization for non-CVD causes and readmission. 9 Although the symptom clusters/pro les were generated according to a close statistical relationship, our results indicate that this concept has clinical relevance. The bene t of using co-occurring symptoms as symptom clusters/pro les lies in their nature as patient-reported and often present before structured clinical assessment, such as NYHA functional class.…”

“…For example, edema/swelling, fatigue, depressive and anxiety symptoms predicted three-month all-cause mortality among people with HF. 9 Depressive and anxiety symptoms were also predictors of mortality in multivariate analysis after adjusting for demographic and clinical covariates. 9 Although most studies focused on individual symptoms, comprehensive assessment of the characteristics of multiple symptoms and their concurrent manifestation as symptom clusters/pro les is crucial for identi cation of HF prognosis.…”

“…9 Depressive and anxiety symptoms were also predictors of mortality in multivariate analysis after adjusting for demographic and clinical covariates. 9 Although most studies focused on individual symptoms, comprehensive assessment of the characteristics of multiple symptoms and their concurrent manifestation as symptom clusters/pro les is crucial for identi cation of HF prognosis. 10 Only one study conducted in South Korea found that membership in a dyspneic symptom cluster (waking up breathless at night, di culty breathing when lying at, shortness of breath) independently predicted mortality in patients with HF during the 12-month follow-up period, after controlling for covariates (p = 0.012).…”

Association between routinely reported symptoms and 3 month hospital admission and mortality risk: a landmark analysis investigation in 86,000 individuals with heart failure in the UK

“…16 Additionally, they may experience other general symptoms that could be related to their HF condition or concurrent medical conditions, including fatigue, pain, and anxiety. 17 Although symptoms are associated with hospitalisations and mortality, 18 they are rarely used in prognosis. 19,20 Symptoms in HF patients often fluctuate over time, meaning that their importance in prognosis may differ according to when they occur.…”