Objectives To 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. Design Nested case–control study with density-based sampling. Setting Clinical Practice Research Datalink, linked to hospitalisation and mortality (1998–2020). Participants Database 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 measures All-cause, HF and non-cardiovascular disease (non-CVD) hospitalisation and mortality. Results During 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). Conclusions In the primary care HF population, routinely recorded cardiac and non-specific symptoms showed differential risk associations with hospitalisation and mortality. Data may be obtained from a third party and are not publicly available. In accordance with the principles of open science and data transparency, we recognise the importance of data sharing. However, we regretfully cannot share the data associated with this study due to the terms of access when we applied for the data via the CPRD. We appreciate the value of data accessibility and encourage any interested parties to contact us to discuss potential collaborations or alternative approaches to address data queries they may have.

中文翻译：

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心力衰竭患者的症状和体征：与 3 个月住院和死亡率的相关性

目的 确定新诊断心力衰竭 (HF) 后初级保健咨询中报告的症状和体征与 3 个月住院治疗和死亡率之间的关联。使用基于密度的抽样设计嵌套病例对照研究。设置与住院和死亡率相关的临床实践研究数据链（1998-2020）。参与者数据库队列由 86882 名新诊断为心力衰竭的患者组成。在针对 (1) 首次住院和 (2) 死亡的两项独立分析中，我们将病例（发生该事件的心力衰竭患者）与其各自的对照（未发生相应事件的心力衰竭患者）的 3 个月症状和体征病史进行了比较，匹配诊断日期（±1个月）和随访时间）。控件可以多次包含，然后成为一个案例。主要结果衡量全因、心力衰竭和非心血管疾病 (non-CVD) 住院率和死亡率。结果 在中位随访时间为 3.22 年（IQR：0.59-8.18）期间，56 677 名患者（65%）首次住院，48 146 名患者（55%）死亡。这些病例分别与 356 714 例和 316 810 例 HF 对照相匹配。对于心力衰竭住院治疗，调整后的关联性最强的是液体超负荷的症状和体征：肺水肿（调整后 OR 3.08；95% CI 2.52，3.64）、呼吸短促（2.94；2.77，3.11）和外周水肿（2.16；2.00， 2.32）。一般症状也显示出显着的相关性：抑郁（1.50；1.18，1.82）、焦虑（1.35；1.06，1.64）和疼痛（1.19；1.10，1.28）。非CVD住院与胸痛（2.93; 2.77, 3.09）、疲劳（1.87; 1.73, 2.01）、全身疼痛（1.87; 1.81, 1.93）和抑郁（1.59; 1.44, 1.74）的相关性最强。结论 在初级保健心力衰竭人群中，常规记录的心脏症状和非特异性症状与住院和死亡率存在不同的风险关联。数据可能从第三方获得，并且不公开。根据开放科学和数据透明的原则，我们认识到数据共享的重要性。然而，遗憾的是，由于我们通过 CPRD 申请数据时的访问条款，我们无法共享与本研究相关的数据。我们赞赏数据可访问性的价值，并鼓励任何感兴趣的各方与我们联系，讨论潜在的合作或解决他们可能遇到的数据查询的替代方法。