{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T17:29:16Z","timestamp":1768757356775,"version":"3.49.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T00:00:00Z","timestamp":1593475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T00:00:00Z","timestamp":1593475200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We sought to describe the frequency, type and timing of clinical events, and delineate patterns in their transitions, after a first episode of heart failure (HF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In 1036 Framingham participants with new-onset HF (mean age 79\u2009years; 53% women), we used mixture models to estimate probabilities of, and time to cardiac death, other cardiovascular disease (CVD) death, recurrent HF, cardiac events and other CVD events, accounting for age, sex, HF type (preserved vs. reduced ejection fraction), and prevalent cardiac\/CVD events. The most common first events after new-onset HF were cardiac (36%), recurrent HF (28%) and death (29%). Compared with recurrent HF (referent transition state), prevalent cardiac events were associated with higher odds of fatal [odds ratio (OR) 1.90, 95% confidence interval (CI) 1.11\u20133.23] and non-fatal (OR 2.13, 95% CI 1.52\u20133.00) cardiac events; prevalent CVD increased odds of other CVD death (OR 1.90, 95% CI 1.04\u20133.47). Among 715 participants without a fatal initial event, there were 3337 distinct epochs (inter-event time periods), with median 3.0 epochs\/participant [49% cardiac (n = 1639); 27% recurrent HF (n = 912)]. Median inter-event times varied between 12 to 285\u2009days (recurrent HF to other CVD death and non-fatal other CVD, respectively). Prior HF, cardiac and other CVD events significantly increased odds of developing the same event-type (OR\u2009\u223c\u20095-7-fold), with shortened time to recurrence, indicating \u2018rapid cycling loops\u2019 of the same event type. HF type did not impact the nature or timing of future events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Comorbidities but not HF type impact clinical course of HF by influencing the type and timing of subsequent events, denoting \u2018natural history loops\u2019 within the overall HF population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.1918","type":"journal-article","created":{"date-parts":[[2020,5,28]],"date-time":"2020-05-28T03:16:14Z","timestamp":1590635774000},"page":"1768-1776","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical Course After a First Episode of Heart Failure: Insights from the Framingham Heart Study"],"prefix":"10.1093","volume":"22","author":[{"given":"Raghava S.","family":"Velagaleti","sequence":"first","affiliation":[{"name":"Framingham Heart Study , Framingham, MA ,","place":["USA"]},{"name":"Cardiology Section, Department of Medicine, Boston VA Healthcare System , West Roxbury, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin G.","family":"Larson","sequence":"additional","affiliation":[{"name":"Framingham Heart Study , Framingham, MA ,","place":["USA"]},{"name":"Department of Mathematics and Statistics, Boston University , Boston, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle","family":"Enserro","sequence":"additional","affiliation":[{"name":"NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center , Buffalo, NY ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca J.","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Boston University School of Public Health , Boston, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramachandran S.","family":"Vasan","sequence":"additional","affiliation":[{"name":"Framingham Heart Study , Framingham, MA ,","place":["USA"]},{"name":"Preventive Medicine and Cardiology Sections, Department of Medicine, School of Medicine, and Department of Epidemiology, School of Public Health, Boston University , Boston, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,6,30]]},"reference":[{"key":"2026011721374065700_ejhf1918-bib-0001","first-page":"e240","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines","volume":"128","author":"Yancy","year":"2013","journal-title":"Circulation"},{"key":"2026011721374065700_ejhf1918-bib-0002","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1093\/eurjhf\/hfs113","article-title":"Why and how do elderly patients with heart failure die? 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