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.
Keywords: Cardiac Epidemiology; Heart failure; Prognosis.
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group.