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Clinical Phenotypes of Atrial Fibrillation and Mortality Risk—A Cluster Analysis from the Nationwide Italian START Registry

Patients with atrial fibrillation (AF) still experience a high mortality rate despite optimal antithrombotic treatment. We aimed to identify clinical phenotypes of patients to stratify mortality risk in AF. Cluster analysis was performed on 5171 AF patients from the nationwide START registry. The ri...

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Autores principales: Pastori, Daniele, Antonucci, Emilia, Milanese, Alberto, Menichelli, Danilo, Palareti, Gualtiero, Farcomeni, Alessio, Pignatelli, Pasquale
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9143727/
https://www.ncbi.nlm.nih.gov/pubmed/35629207
http://dx.doi.org/10.3390/jpm12050785
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author Pastori, Daniele
Antonucci, Emilia
Milanese, Alberto
Menichelli, Danilo
Palareti, Gualtiero
Farcomeni, Alessio
Pignatelli, Pasquale
author_facet Pastori, Daniele
Antonucci, Emilia
Milanese, Alberto
Menichelli, Danilo
Palareti, Gualtiero
Farcomeni, Alessio
Pignatelli, Pasquale
author_sort Pastori, Daniele
collection PubMed
description Patients with atrial fibrillation (AF) still experience a high mortality rate despite optimal antithrombotic treatment. We aimed to identify clinical phenotypes of patients to stratify mortality risk in AF. Cluster analysis was performed on 5171 AF patients from the nationwide START registry. The risk of all-cause mortality in each cluster was analyzed. We identified four clusters. Cluster 1 was composed of the youngest patients, with low comorbidities; Cluster 2 of patients with low cardiovascular risk factors and high prevalence of cancer; Cluster 3 of men with diabetes and coronary disease and peripheral artery disease; Cluster 4 included the oldest patients, mainly women, with previous cerebrovascular events. During 9857 person-years of observation, 386 deaths (3.92%/year) occurred. Mortality rates increased across clusters: 0.42%/year (cluster 1, reference group), 2.12%/year (cluster 2, adjusted hazard ratio (aHR) 3.306, 95% confidence interval (CI) 1.204–9.077, p = 0.020), 4.41%/year (cluster 3, aHR 6.702, 95%CI 2.433–18.461, p < 0.001), and 8.71%/year (cluster 4, aHR 8.927, 95%CI 3.238–24.605, p < 0.001). We identified four clusters of AF patients with progressive mortality risk. The use of clinical phenotypes may help identify patients at a higher risk of mortality.
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spelling pubmed-91437272022-05-29 Clinical Phenotypes of Atrial Fibrillation and Mortality Risk—A Cluster Analysis from the Nationwide Italian START Registry Pastori, Daniele Antonucci, Emilia Milanese, Alberto Menichelli, Danilo Palareti, Gualtiero Farcomeni, Alessio Pignatelli, Pasquale J Pers Med Article Patients with atrial fibrillation (AF) still experience a high mortality rate despite optimal antithrombotic treatment. We aimed to identify clinical phenotypes of patients to stratify mortality risk in AF. Cluster analysis was performed on 5171 AF patients from the nationwide START registry. The risk of all-cause mortality in each cluster was analyzed. We identified four clusters. Cluster 1 was composed of the youngest patients, with low comorbidities; Cluster 2 of patients with low cardiovascular risk factors and high prevalence of cancer; Cluster 3 of men with diabetes and coronary disease and peripheral artery disease; Cluster 4 included the oldest patients, mainly women, with previous cerebrovascular events. During 9857 person-years of observation, 386 deaths (3.92%/year) occurred. Mortality rates increased across clusters: 0.42%/year (cluster 1, reference group), 2.12%/year (cluster 2, adjusted hazard ratio (aHR) 3.306, 95% confidence interval (CI) 1.204–9.077, p = 0.020), 4.41%/year (cluster 3, aHR 6.702, 95%CI 2.433–18.461, p < 0.001), and 8.71%/year (cluster 4, aHR 8.927, 95%CI 3.238–24.605, p < 0.001). We identified four clusters of AF patients with progressive mortality risk. The use of clinical phenotypes may help identify patients at a higher risk of mortality. MDPI 2022-05-12 /pmc/articles/PMC9143727/ /pubmed/35629207 http://dx.doi.org/10.3390/jpm12050785 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pastori, Daniele
Antonucci, Emilia
Milanese, Alberto
Menichelli, Danilo
Palareti, Gualtiero
Farcomeni, Alessio
Pignatelli, Pasquale
Clinical Phenotypes of Atrial Fibrillation and Mortality Risk—A Cluster Analysis from the Nationwide Italian START Registry
title Clinical Phenotypes of Atrial Fibrillation and Mortality Risk—A Cluster Analysis from the Nationwide Italian START Registry
title_full Clinical Phenotypes of Atrial Fibrillation and Mortality Risk—A Cluster Analysis from the Nationwide Italian START Registry
title_fullStr Clinical Phenotypes of Atrial Fibrillation and Mortality Risk—A Cluster Analysis from the Nationwide Italian START Registry
title_full_unstemmed Clinical Phenotypes of Atrial Fibrillation and Mortality Risk—A Cluster Analysis from the Nationwide Italian START Registry
title_short Clinical Phenotypes of Atrial Fibrillation and Mortality Risk—A Cluster Analysis from the Nationwide Italian START Registry
title_sort clinical phenotypes of atrial fibrillation and mortality risk—a cluster analysis from the nationwide italian start registry
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9143727/
https://www.ncbi.nlm.nih.gov/pubmed/35629207
http://dx.doi.org/10.3390/jpm12050785
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