{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T20:15:34Z","timestamp":1791663334440,"version":"4.3.4"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":372,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["RG\/F\/22\/110076"],"award-info":[{"award-number":["RG\/F\/22\/110076"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["RG\/F\/22\/110076"],"award-info":[{"award-number":["RG\/F\/22\/110076"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Heart failure (HF) is frequently associated with multiple comorbidities. We aimed to define their trajectory of accrual to identify opportunities for disease prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We identified all participants in the UK Biobank cohort study diagnosed with HF prior to enrolment or during follow-up, who had disease occurrence data available from both primary and secondary care records (n\u2009=\u20099824). We established the time between diagnosis of HF and 16 common comorbidities to determine the rate and sequence of comorbidity accrual in relation to HF. Stratified analyses considered associations with sex and age at diagnosis of HF. In chronological sequence, HF was the median fourth diagnosis for men and women. As the age at HF diagnosis increased, HF came later in the sequence of diseases (median second in under 50\u2009years to fifth in those aged 80\u201390\u2009years). In all age strata, comorbidities accumulated for over a decade before HF and this accelerated in the years immediately before HF. The median time between comorbidity and HF diagnoses ranged from depression preceding HF by 10.7\u2009years to dementia proceeding HF by 0.7\u2009years; all comorbidities presented earlier in women. Atrial fibrillation\/flutter was the commonest disease to immediately precede HF, followed by hypertension, cancer, myocardial infarction and osteoarthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Heart failure is most often diagnosed in people with established multiple long-term conditions. There is a protracted window of opportunity during which interventions to prevent HF could be applied, often in disease contexts where this is not routine care, such as cancer and osteoarthritis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3601","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T01:15:43Z","timestamp":1739322943000},"page":"2259-2269","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Comorbidity Trajectories Before and After the Diagnosis of Heart Failure: A UK Biobank Cohort Study"],"prefix":"10.1093","volume":"27","author":[{"given":"Hugo","family":"MacGowan","sequence":"first","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver I.","family":"Brown","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Drozd","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.N.","family":"Walker","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilena","family":"Giannoudi","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Straw","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria F.","family":"Paton","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Gierula","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"McGinlay","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn J.","family":"Griffin","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus K.","family":"Witte","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark T.","family":"Kearney","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Cubbon","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"2026021721494918800_ejhf3601-bib-0001","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"Skou","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2026021721494918800_ejhf3601-bib-0002","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study","volume":"380","author":"Barnett","year":"2012","journal-title":"Lancet"},{"key":"2026021721494918800_ejhf3601-bib-0003","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1038\/s41746-024-01015-w","article-title":"Unraveling cradle-to-grave disease trajectories from multilayer comorbidity networks","volume":"7","author":"Dervi\u0107","year":"2024","journal-title":"NPJ Digit Med"},{"key":"2026021721494918800_ejhf3601-bib-0004","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.7497","article-title":"Trajectories of chronic disease and multimorbidity among middle-aged and older patients at community health centers","volume":"6","author":"Qui\u00f1ones","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026021721494918800_ejhf3601-bib-0005","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1186\/s12889-016-3335-z","article-title":"Patterns of multimorbidity and their association with health outcomes within Yorkshire, England: Baseline results from the Yorkshire health study","volume":"16","author":"Li","year":"2016","journal-title":"BMC Public Health"},{"key":"2026021721494918800_ejhf3601-bib-0006","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: A comprehensive and updated review of epidemiology","volume":"118","author":"Savarese","year":"2023","journal-title":"Cardiovasc Res"},{"key":"2026021721494918800_ejhf3601-bib-0007","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1161\/CIRCHEARTFAILURE.110.959882","article-title":"Changing characteristics and mode of death associated with chronic heart failure caused by left ventricular systolic dysfunction: A study across therapeutic eras","volume":"4","author":"Cubbon","year":"2011","journal-title":"Circ Heart Fail"},{"key":"2026021721494918800_ejhf3601-bib-0008","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/S0140-6736(17)32520-5","article-title":"Temporal trends and patterns in heart failure incidence: A population-based study of 4 million individuals","volume":"391","author":"Conrad","year":"2018","journal-title":"Lancet"},{"key":"2026021721494918800_ejhf3601-bib-0009","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1136\/heartjnl-2020-317833","article-title":"Association of heart failure and its comorbidities with loss of life expectancy","volume":"107","author":"Drozd","year":"2021","journal-title":"Heart"},{"key":"2026021721494918800_ejhf3601-bib-0010","doi-asserted-by":"crossref","first-page":"3859","DOI":"10.1002\/ehf2.12978","article-title":"Effect of disease-modifying agents and their association with mortality in multi-morbid patients with heart failure with reduced ejection fraction","volume":"7","author":"Straw","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2026021721494918800_ejhf3601-bib-0011","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1016\/S1473-3099(20)30978-6","article-title":"Non-communicable disease, sociodemographic factors, and risk of death from infection: A UK Biobank observational cohort study","volume":"21","author":"Drozd","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"2026021721494918800_ejhf3601-bib-0012","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.2337\/dc23-0294","article-title":"Relationship among diabetes, obesity, and cardiovascular disease phenotypes: A UK Biobank cohort study","volume":"46","author":"Brown","year":"2023","journal-title":"Diabetes Care"},{"key":"2026021721494918800_ejhf3601-bib-0013","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s10654-023-01095-0","article-title":"Assessing the importance of primary care diagnoses in the UK Biobank","volume":"39","author":"Clifton","year":"2024","journal-title":"Eur J Epidemiol"},{"key":"2026021721494918800_ejhf3601-bib-0014","doi-asserted-by":"crossref","DOI":"10.21105\/joss.01686","article-title":"Welcome to the tidyverse","volume":"4","author":"Wickham","year":"2019","journal-title":"J Open Source Softw"},{"key":"2026021721494918800_ejhf3601-bib-0015","doi-asserted-by":"crossref","first-page":"L28","DOI":"10.1093\/eurheartj\/suz242","article-title":"Dementia and the heart failure patient","volume":"21","author":"Doehner","year":"2019","journal-title":"Eur Heart J Suppl"},{"key":"2026021721494918800_ejhf3601-bib-0016","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.119.006746","article-title":"Infection-related hospitalization in heart failure with reduced ejection fraction: A prospective observational cohort study","volume":"13","author":"Drozd","year":"2020","journal-title":"Circ Heart Fail"},{"key":"2026021721494918800_ejhf3601-bib-0017","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1001\/jamacardio.2019.3593","article-title":"Temporal trends and patterns in mortality after incident heart failure: A longitudinal analysis of 86\u2009000 individuals","volume":"4","author":"Conrad","year":"2019","journal-title":"JAMA Cardiol"},{"key":"2026021721494918800_ejhf3601-bib-0018","doi-asserted-by":"crossref","first-page":"3298","DOI":"10.1002\/ehf2.14051","article-title":"Reduction of heart failure guideline-directed medication during hospitalization: Prevalence, risk factors, and outcomes","volume":"9","author":"Palin","year":"2022","journal-title":"ESC Heart Fail"},{"key":"2026021721494918800_ejhf3601-bib-0019","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1093\/aje\/kwx246","article-title":"Comparison of sociodemographic and health-related characteristics of UK Biobank participants with those of the general population","volume":"186","author":"Fry","year":"2017","journal-title":"Am J Epidemiol"},{"key":"2026021721494918800_ejhf3601-bib-0020","doi-asserted-by":"crossref","first-page":"4637","DOI":"10.1016\/j.cell.2024.06.028","article-title":"Innate immune memory after brain injury drives inflammatory cardiac dysfunction","volume":"187","author":"Simats","year":"2024","journal-title":"Cell"},{"key":"2026021721494918800_ejhf3601-bib-0021","doi-asserted-by":"crossref","DOI":"10.1126\/sciimmunol.ade3814","article-title":"Heart failure promotes multimorbidity through innate immune memory","volume":"9","author":"Nakayama","year":"2024","journal-title":"Sci Immunol"},{"key":"2026021721494918800_ejhf3601-bib-0022","doi-asserted-by":"crossref","first-page":"509","DOI":"10.7326\/M20-0527","article-title":"Effects of interleukin-1\u03b2 inhibition on incident hip and knee replacement: Exploratory analyses from a randomized, double-blind, placebo-controlled trial","volume":"173","author":"Schieker","year":"2020","journal-title":"Ann Intern Med"},{"key":"2026021721494918800_ejhf3601-bib-0023","doi-asserted-by":"crossref","first-page":"535","DOI":"10.7326\/M18-1167","article-title":"Relationship of interleukin-1\u03b2 blockade with incident gout and serum uric acid levels: Exploratory analysis of a randomized controlled trial","volume":"169","author":"Solomon","year":"2018","journal-title":"Ann Intern Med"},{"key":"2026021721494918800_ejhf3601-bib-0024","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1056\/NEJMoa1707914","article-title":"Antiinflammatory therapy with canakinumab for atherosclerotic disease","volume":"377","author":"Ridker","year":"2017","journal-title":"N Engl J Med"},{"key":"2026021721494918800_ejhf3601-bib-0025","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1161\/CIRCULATIONAHA.118.038010","article-title":"Anti-inflammatory therapy with canakinumab for the prevention of hospitalization for heart failure","volume":"139","author":"Everett","year":"2019","journal-title":"Circulation"},{"key":"2026021721494918800_ejhf3601-bib-0026","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1016\/S0140-6736(17)32247-X","article-title":"Effect of interleukin-1\u03b2; inhibition with canakinumab on incident lung cancer in patients with atherosclerosis: Exploratory results from a randomised, double-blind, placebo-controlled trial","volume":"390","author":"Ridker","year":"2017","journal-title":"Lancet"},{"key":"2026021721494918800_ejhf3601-bib-0027","doi-asserted-by":"crossref","first-page":"523","DOI":"10.7326\/M19-2945","article-title":"Effects of interleukin-1\u03b2 inhibition on incident anemia: Exploratory analyses from a randomized trial","volume":"172","author":"Vallurupalli","year":"2020","journal-title":"Ann Intern Med"},{"key":"2026021721494918800_ejhf3601-bib-0028","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1161\/CIRCRESAHA.121.319901","article-title":"Sex-specific cardiovascular risks of cancer and its therapies","volume":"130","author":"Wilcox","year":"2022","journal-title":"Circ Res"},{"key":"2026021721494918800_ejhf3601-bib-0029","doi-asserted-by":"crossref","DOI":"10.1038\/srep39672","article-title":"Osteoarthritis and the risk of cardiovascular disease: A meta-analysis of observational studies","volume":"6","author":"Wang","year":"2016","journal-title":"Sci Rep"},{"key":"2026021721494918800_ejhf3601-bib-0030","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/S0140-6736(19)31674-5","article-title":"Medium and long-term risks of specific cardiovascular diseases in survivors of 20 adult cancers: A population-based cohort study using multiple linked UK electronic health records databases","volume":"394","author":"Strongman","year":"2019","journal-title":"Lancet"},{"key":"2026021721494918800_ejhf3601-bib-0031","doi-asserted-by":"crossref","first-page":"4229","DOI":"10.1093\/eurheartj\/ehac244","article-title":"2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the international Cardio-Oncology Society (IC-OS)","volume":"43","author":"Lyon","year":"2022","journal-title":"Eur Heart J"},{"key":"2026021721494918800_ejhf3601-bib-0032","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/s11764-022-01212-0","article-title":"Adherence to cardiovascular disease risk factor medications among patients with cancer: A systematic review","volume":"17","author":"Zullig","year":"2023","journal-title":"J Cancer Surviv"},{"key":"2026021721494918800_ejhf3601-bib-0033","article-title":"Reweighting UK Biobank corrects for pervasive selection bias due to volunteering","volume":"53","author":"Alten","year":"2024","journal-title":"Int J Epidemiol"},{"key":"2026021721494918800_ejhf3601-bib-0034","doi-asserted-by":"crossref","DOI":"10.1136\/bmjmed-2022-000247","article-title":"Measuring multimorbidity in research: Delphi consensus study","volume":"1","author":"Ho","year":"2022","journal-title":"BMJ Med"},{"key":"2026021721494918800_ejhf3601-bib-0035","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1038\/nrcardio.2017.65","article-title":"Epidemiology of heart failure with preserved ejection fraction","volume":"14","author":"Dunlay","year":"2017","journal-title":"Nat Rev Cardiol"},{"key":"2026021721494918800_ejhf3601-bib-0036","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2024-002711","article-title":"Adiposity, fat-free mass and incident heart failure in 500\u2009000 individuals","volume":"11","author":"Oguntade","year":"2024","journal-title":"Open Heart"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/27\/11\/2259\/66833826\/eurjhf_27_11_2259.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/27\/11\/2259\/66833826\/eurjhf_27_11_2259.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T02:49:55Z","timestamp":1771382995000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjhf\/article\/27\/11\/2259\/8470254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,11]]},"references-count":36,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,2,11]]},"published-print":{"date-parts":[[2025,11,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ejhf.3601","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.08.28.24312712","asserted-by":"object"}]},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,2,11]]},"assertion":[{"value":"2024-11-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}