Abstract

Introduction The vast majority of people with heart failure (HF) have at least one comorbidity, and it is known that a greater burden of comorbidity is associated with poorer outcomes. Despite this, the chronology of comorbidity development in HF has not been investigated. We explored this using the UK Biobank cohort study and hypothesised that HF is preceded by most of its comorbidities. Methods UK Biobank participants were selected if they had available primary care records and HF diagnosed at any stage before or after recruitment, resulting in a sample size of 21,127. Diagnoses of HF and comorbidities were not considered if only self-reported or of unknown date. Comorbidity categories were based on those selected by Conrad et al (Lancet 2018; 391(10120): 572–580), and defined using CALIBER or UK Biobank criteria. We investigated the time between first diagnosis of HF and first diagnosis of 15 common comorbidities, including analyses stratified by sex and age of HF diagnosis. Data analysis was completed in the UK Biobank Research Access Platform using RStudio. Results For all comorbidities we studied, except dementia, at least half of diagnoses predated or developed synchronously with HF (figure 1). For 7 of these (myocardial infarction, obesity, cancer, atrial fibrillation, hypertension, diabetes and depression), at least three quarters of diagnoses predated or developed synchronously with HF. However, the median time between comorbidity and HF diagnoses varied substantially between comorbidities, ranging from depression preceding HF by 10.7 years to dementia proceeding HF by 0.7 years. There was also substantial variation in the interquartile range of time between comorbidity and HF diagnoses, ranging from 2.4 years for myocardial infarction to 15.2 years for depression, indicating most cases of the former develop in a narrow window in relation to HF diagnosis. All comorbidities presented earlier in women, with this being most pronounced for cancer (median time between cancer and HF -2.6 years for men and -7.1 years for women). As the age at which HF was diagnosed increased, the time spent with all studied comorbidities also increased. Notably, when HF was diagnosed before the age of 60, a majority of comorbidity diagnoses (except for depression) occurred after HF. Conclusion HF is most often diagnosed after the other diseases it is associated with. However, the patterns of comorbidity development differ substantially in relation to sex and the age of HF diagnosis. These data illustrate substantial windows of opportunity to prevent HF and its comorbidities, which have the prospect to improve patient outcomes, but are likely to require a personalised approach. Conflict of Interest None