Yu Horiuchi1, Shuzou Tanimoto2, A H M Mahbub Latif3, Kevin Y Urayama4, Jiro Aoki2, Kazuyuki Yahagi2, Taishi Okuno2, Yu Sato2, Tetsu Tanaka2, Keita Koseki2, Kota Komiyama2, Hiroyoshi Nakajima5, Kazuhiro Hara6, Kengo Tanabe2. 1. Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan. Electronic address: yooouyou@gmail.com. 2. Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan. 3. Graduate School of Public Health, St. Luke's International University, Tokyo, Japan; Institute of Statistical Research and Training, University of Dhaka, Dhaka 1000, Bangladesh. 4. Graduate School of Public Health, St. Luke's International University, Tokyo, Japan; Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan. 5. Division of General Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan. 6. Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan.
Abstract
BACKGROUND: Acute heart failure (AHF) is a heterogeneous disease caused by various cardiovascular (CV) pathophysiology and multiple non-CV comorbidities. We aimed to identify clinically important subgroups to improve our understanding of the pathophysiology of AHF and inform clinical decision-making. METHODS: We evaluated detailed clinical data of 345 consecutive AHF patients using non-hierarchical cluster analysis of 77 variables, including age, sex, HF etiology, comorbidities, physical findings, laboratory data, electrocardiogram, echocardiogram and treatment during hospitalization. Cox proportional hazards regression analysis was performed to estimate the association between the clusters and clinical outcomes. RESULTS: Three clusters were identified. Cluster 1 (n=108) represented "vascular failure". This cluster had the highest average systolic blood pressure at admission and lung congestion with type 2 respiratory failure. Cluster 2 (n=89) represented "cardiac and renal failure". They had the lowest ejection fraction (EF) and worst renal function. Cluster 3 (n=148) comprised mostly older patients and had the highest prevalence of atrial fibrillation and preserved EF. Death or HF hospitalization within 12-month occurred in 23% of Cluster 1, 36% of Cluster 2 and 36% of Cluster 3 (p=0.034). Compared with Cluster 1, risk of death or HF hospitalization was 1.74 (95% CI, 1.03-2.95, p=0.037) for Cluster 2 and 1.82 (95% CI, 1.13-2.93, p=0.014) for Cluster 3. CONCLUSIONS: Cluster analysis may be effective in producing clinically relevant categories of AHF, and may suggest underlying pathophysiology and potential utility in predicting clinical outcomes.
BACKGROUND: Acute heart failure (AHF) is a heterogeneous disease caused by various cardiovascular (CV) pathophysiology and multiple non-CV comorbidities. We aimed to identify clinically important subgroups to improve our understanding of the pathophysiology of AHF and inform clinical decision-making. METHODS: We evaluated detailed clinical data of 345 consecutive AHF patients using non-hierarchical cluster analysis of 77 variables, including age, sex, HF etiology, comorbidities, physical findings, laboratory data, electrocardiogram, echocardiogram and treatment during hospitalization. Cox proportional hazards regression analysis was performed to estimate the association between the clusters and clinical outcomes. RESULTS: Three clusters were identified. Cluster 1 (n=108) represented "vascular failure". This cluster had the highest average systolic blood pressure at admission and lung congestion with type 2 respiratory failure. Cluster 2 (n=89) represented "cardiac and renal failure". They had the lowest ejection fraction (EF) and worst renal function. Cluster 3 (n=148) comprised mostly older patients and had the highest prevalence of atrial fibrillation and preserved EF. Death or HF hospitalization within 12-month occurred in 23% of Cluster 1, 36% of Cluster 2 and 36% of Cluster 3 (p=0.034). Compared with Cluster 1, risk of death or HF hospitalization was 1.74 (95% CI, 1.03-2.95, p=0.037) for Cluster 2 and 1.82 (95% CI, 1.13-2.93, p=0.014) for Cluster 3. CONCLUSIONS: Cluster analysis may be effective in producing clinically relevant categories of AHF, and may suggest underlying pathophysiology and potential utility in predicting clinical outcomes.
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