Phenotypes and outcomes in non-anticoagulated patients with atrial fibrillation: An unsupervised cluster analysis.

Bisson, Arnaud ORCID: 0000-0002-3449-1800, M Fawzy, Ameenathul, Romiti, Giulio Francesco, Proietti, Marco ORCID: 0000-0003-1452-2478, Angoulvant, Denis, El-Bouri, Wahbi ORCID: 0000-0002-2732-5927, Y H Lip, Gregory and Fauchier, Laurent (2023) Phenotypes and outcomes in non-anticoagulated patients with atrial fibrillation: An unsupervised cluster analysis. Archives of cardiovascular diseases, 116 (6-7). S1875-2136(23)00120-1-S1875-2136(23)00120-1.

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Abstract

<h4>Background</h4>Patients with atrial fibrillation are characterized by great clinical heterogeneity and complexity. The usual classifications may not adequately characterize this population. Data-driven cluster analysis reveals different possible patient classifications.<h4>Aims</h4>To identify different clusters of patients with atrial fibrillation who share similar clinical phenotypes, and to evaluate the association between identified clusters and clinical outcomes, using cluster analysis.<h4>Methods</h4>An agglomerative hierarchical cluster analysis was performed in non-anticoagulated patients from the Loire Valley Atrial Fibrillation cohort. Associations between clusters and a composite outcome comprising stroke/systemic embolism/death and all-cause death, stroke and major bleeding were evaluated using Cox regression analyses.<h4>Results</h4>The study included 3434 non-anticoagulated patients with atrial fibrillation (mean age 70.3±17 years; 42.8% female). Three clusters were identified: cluster 1 was composed of younger patients, with a low prevalence of co-morbidities; cluster 2 included old patients with permanent atrial fibrillation, cardiac pathologies and a high burden of cardiovascular co-morbidities; cluster 3 identified old female patients with a high burden of cardiovascular co-morbidities. Compared with cluster 1, clusters 2 and 3 were independently associated with an increased risk of the composite outcome (hazard ratio 2.85, 95% confidence interval 1.32-6.16 and hazard ratio 1.52, 95% confidence interval 1.09-2.11, respectively) and all-cause death (hazard ratio 3.54, 95% confidence interval 1.49-8.43 and hazard ratio 1.88, 95% confidence interval 1.26-2.79, respectively). Cluster 3 was independently associated with an increased risk of major bleeding (hazard ratio 1.72, 95% confidence interval 1.06-2.78).<h4>Conclusion</h4>Cluster analysis identified three statistically driven groups of patients with atrial fibrillation, with distinct phenotype characteristics and associated with different risks for major clinical adverse events.

Item Type:	Article
Uncontrolled Keywords:	Atrial fibrillation, Cluster analysis, Outcomes, Machine learning
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	20 Jul 2023 07:19
Last Modified:	25 Aug 2023 04:01
DOI:	10.1016/j.acvd.2023.06.001
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3171769