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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.
by Mansuk Daniel Han, Thomas Yates, Kamlesh Khunti, Cameron Razieh, Francesco Zaccardi
Multimorbidity, or multiple long-term conditions (MLTC), is a growing public health concern with implications for quality of life, healthcare utilisation, and premature mortality. Classical explanations for MLTC often treat sociodemographic categories as independent predictors, overlooking the relational dynamics of health inequalities. This systematic review examines how MLTC outcomes vary at the intersections of sociodemographic factors within their relational context. We conducted a systematic search of PubMed, Medline, and Scopus to identify 792 studies. Four studies met inclusion criteria but none were longitudinal, which limits our ability to examine the role of intersectional effects on MLTC outcomes over the life course from this review. A narrative synthesis was conducted due to their wide heterogeneity among the MLTC outcomes of the studies included in this review. The limited evidence may potentially suggest that MLTC outcomes can vary considerably at the intersections of sociodemographic factors. All four studies in this review suggested that the association of income with MLTC outcomes can vary by what other sociodemographic factors it intersects with. The role of disability on MLTC outcomes varied when intersected with ethnicity, at least in the US racial context. A low level of education is a known MLTC risk factor, but when intersected with ethnicity for both men and women in the South African setting, definitive cumulative disadvantages were not found in the projected life expectancy. Future intersectionality-informed quantitative MLTC research should prioritise using longitudinal data and solution-linked variables to inform context-responsive interventions.
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