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Meijs, C. ; Brugts, J.J.* ; Lund, L.H.* ; Linssen, G.C.M.* ; Rocca, H.B.* ; Dahlström, U.* ; Vaartjes, I.* ; Koudstaal, S.* ; Asselbergs, F.W.* ; Savarese, G.* ; Uijl, A.*

Identifying distinct clinical clusters in heart failure with mildly reduced ejection fraction.

Int. J. Cardiol. 386, 83-90 (2023)

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INTRODUCTION: Heart failure (HF) is a heterogeneous syndrome, and the specific sub-category HF with mildly reduced ejection fraction (EF) range (HFmrEF; 41-49% EF) is only recently recognised as a distinct entity. Cluster analysis can characterise heterogeneous patient populations and could serve as a stratification tool in clinical trials and for prognostication. The aim of this study was to identify clusters in HFmrEF and compare cluster prognosis. METHODS AND RESULTS: Latent class analysis to cluster HFmrEF patients based on their characteristics was performed in the Swedish HF registry (n = 7316). Identified clusters were validated in a Dutch cross-sectional HF registry-based dataset CHECK-HF (n = 1536). In Sweden, mortality and hospitalisation across the clusters were compared using a Cox proportional hazard model, with a Fine-Gray sub-distribution for competing risks and adjustment for age and sex. Six clusters were discovered with the following prevalence and hazard ratio with 95% confidence intervals (HR [95%CI]) vs. cluster 1: 1) low-comorbidity (17%, reference), 2) ischaemic-male (13%, HR 0.9 [95% CI 0.7-1.1]), 3) atrial fibrillation (20%, HR 1.5 [95% CI 1.2-1.9]), 4) device/wide QRS (9%, HR 2.7 [95% CI 2.2-3.4]), 5) metabolic (19%, HR 3.1 [95% CI 2.5-3.7]) and 6) cardio-renal phenotype (22%, HR 2.8 [95% CI 2.2-3.6]). The cluster model was robust between both datasets. CONCLUSION: We found robust clusters with potential clinical meaning and differences in mortality and hospitalisation. Our clustering model could be valuable as a clinical differentiation support and prognostic tool in clinical trial design.

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Publication type Article: Journal article

Document type Scientific Article

Corresponding Author

Keywords Clustering ; Heart Failure With Mildly Reduced Ejection Fraction ; Heterogeneity ; Latent Class Analysis; Atrial-fibrillation; Midrange; Association; Dysfunction; Outcomes; Common

ISSN (print) / ISBN 0167-5273

e-ISSN 1874-1754

Journal International Journal of Cardiology

Quellenangaben Volume: 386, Pages: 83-90

Publisher Elsevier

Publishing Place Elsevier House, Brookvale Plaza, East Park Shannon, Co, Clare, 00000, Ireland

Non-patent literature Publications

Reviewing status Peer reviewed

Institute(s) Institute of Computational Biology (ICB)

Grants Dutch Heart Foundation
UCL Hospitals NIHR Biomedical Research Centre
Stockholm County Council
Swedish Heart Lung Foundation
Swedish Research Council
EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking BigData@Heart
Servier, the Netherlands
Swedish Heart-Lung Foundation
Swedish Society of Cardiology
Swedish Association of Local Authorities and Regions
Swedish National Board of Health and Welfare