Prognostic Clinical Phenotypes of Patients with Acute Decompensated Heart Failure.

IF 3.1 Q2 PERIPHERAL VASCULAR DISEASE High Blood Pressure & Cardiovascular Prevention Pub Date : 2023-09-01 Epub Date: 2023-09-05 DOI:10.1007/s40292-023-00598-x
Tanya Mohammadi, Said Tofighi, Babak Mohammadi, Shadi Halimi, Farshad Gharebakhshi
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引用次数: 0

Abstract

Introduction: Acute decompensated heart failure (AHF) is a clinical syndrome with a poor prognosis.

Aim: This study was conducted to identify clusters of inpatients with acute decompensated heart failure that shared similarities in their clinical features.

Methods: We analyzed data from a cohort of patients with acute decompensated heart failure hospitalized between February 2013 and January 2017 in a Department of Cardiology. Patients were clustered using factorial analysis of mixed data. The clusters (phenotypes) were then compared using log-rank tests and profiled using a logistic model. In total, 458 patients (255; 55.7% male) with a mean (SD) age of 72.7 (11.1) years were included in the analytic dataset. The demographic, clinical, and laboratory features were included in the cluster analysis.

Results: The two clusters were significantly different in terms of time to mortality and re-hospitalization (all P < 0.001). Cluster profiling yielded an accurate discriminating model (AUC = 0.934). Typically, high-risk patients were elderly females with a lower estimated glomerular filtration rate and hemoglobin on admission compared to the low-risk phenotype. Moreover, the high-risk phenotype had a higher likelihood of diabetes type 2, transient ischemic attack/cerebrovascular accident, previous heart failure or ischemic heart disease, and a higher serum potassium concentration on admission. Patients with the high-risk phenotype were of higher New York Heart Association functional classes and more positive in their medication history.

Conclusions: There are two phenotypes among patients with decompensated heart failure, high-risk and low-risk for mortality and re-hospitalization. They can be distinguished by easy-to-measure patients' characteristics.

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急性失代偿性心力衰竭患者的预后临床表型。
引言:急性失代偿性心力衰竭是一种预后不良的临床综合征。目的:本研究旨在确定具有相似临床特征的急性失代偿性心力衰竭住院患者集群。方法:我们分析了2013年2月至2017年1月在心内科住院的急性失代偿性心力衰竭患者的队列数据。使用混合数据的析因分析对患者进行聚类。然后使用对数秩检验对聚类(表型)进行比较,并使用逻辑模型进行分析。分析数据集中总共包括458名患者(255名;55.7%为男性),平均(SD)年龄为72.7(11.1)岁。聚类分析包括人口统计学、临床和实验室特征。结果:两个聚类在死亡率和再次住院时间方面存在显著差异(均P<0.001)。聚类分析产生了准确的判别模型(AUC=0.934)。通常,高危患者是老年女性,与低风险表型相比,其入院时的肾小球滤过率和血红蛋白估计值较低。此外,高危表型患2型糖尿病、短暂性脑缺血发作/脑血管意外、既往心力衰竭或缺血性心脏病的可能性更高,入院时血清钾浓度更高。具有高危表型的患者具有较高的纽约心脏协会功能分类,且其用药史更为阳性。结论:失代偿性心力衰竭患者有两种表型,即死亡和再次住院的高风险和低风险。它们可以通过易于测量的患者特征来区分。
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来源期刊
CiteScore
5.70
自引率
3.30%
发文量
57
期刊介绍: High Blood Pressure & Cardiovascular Prevention promotes knowledge, update and discussion in the field of hypertension and cardiovascular disease prevention, by providing a regular programme of independent review articles covering key aspects of the management of hypertension and cardiovascular diseases. The journal includes:   Invited ''State of the Art'' reviews.  Expert commentaries on guidelines, major trials, technical advances.Presentation of new intervention trials design.''Pros and Cons'' or round tables on controversial issues.Statements on guidelines from hypertension and cardiovascular scientific societies.Socio-economic issues.Cost/benefit in prevention of cardiovascular diseases.Monitoring of healthcare systems.News and views from the Italian Society of Hypertension (including abstracts).All manuscripts are subject to peer review by international experts. Letters to the editor are welcomed and will be considered for publication.
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