Uijl, A;
Savarese, G;
Vaartjes, I;
Dahlström, U;
Brugts, JJ;
Linssen, GC;
van Empel, V;
... Koudstaal, S; + view all
(2021)
Identification of distinct phenotypic clusters in heart failure with preserved ejection fraction.
European Journal of Heart Failure
, 23
(6)
pp. 973-982.
10.1002/ejhf.2169.
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Abstract
AIMS: We aimed to derive and validate clinically useful clusters of patients with heart failure with preserved ejection fraction (HFpEF; left ventricular ejection fraction ≥50%). METHODS AND RESULTS: We derived a cluster model from 6909 HFpEF patients from the Swedish Heart Failure Registry (SwedeHF) and externally validated this in 2153 patients from the Chronic Heart Failure ESC-guideline based Cardiology Practice Quality project (CHECK-HF) registry. In SwedeHF, the median age was 80 [interquartile range 72-86] years, 52% of patients were female and most frequent comorbidities were hypertension (82%), atrial fibrillation (68%), and ischaemic heart disease (48%). Latent class analysis identified five distinct clusters: Cluster 1 (10% of patients) were young patients with a low comorbidity burden and the highest proportion implantable devices, cluster 2 (30%) patients had atrial fibrillation, hypertension without diabetes, cluster 3 (25%) patients were the oldest with many cardiovascular comorbidities and hypertension, cluster 4 (15%) patients had obesity, diabetes and hypertension, and cluster 5 (20%) patients were older with ischaemic heart disease, hypertension and renal failure and were most frequently prescribed diuretics. The clusters were reproduced in the CHECK-HF cohort. Patients in cluster 1 had the best prognosis, while patients in cluster 3 and 5 had the worst age- and sex adjusted prognosis. CONCLUSIONS: Five distinct clusters of HFpEF patients were identified that differed in clinical characteristics, HF drug therapy and prognosis. These results confirm the heterogeneity of HFpEF and form a basis for tailoring trial design to individualised drug therapy in HFpEF patients. This article is protected by copyright. All rights reserved.
| Type: | Article |
|---|---|
| Title: | Identification of distinct phenotypic clusters in heart failure with preserved ejection fraction |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1002/ejhf.2169 |
| Publisher version: | https://doi.org/10.1002/ejhf.2169 |
| Language: | English |
| Additional information: | Copyright © 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
| Keywords: | Heart failure with preserved ejection fraction, clusters, comorbidities, external validation, latent class analysis, phenotyping, treatment |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10126822 |
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