Download This Paper
Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
A Data-Driven Cluster Analysis of Stroke Phenotypes in Asian Patients with Atrial Fibrillation: Refinement of the CHA2DS2-VASc Score
35 Pages Posted: 20 Jul 2022
More...Abstract
Introduction: Atrial fibrillation (AF) is a disease with heterogeneous underlying conditions which usually encompass several cardiovascular comorbidities. There is a lack of large studies investigating the heterogeneity of patients with AF in Asian population. A refined classification may contribute on individual precise treatment and prognosis.
Methods: This cohort study was conducted utilizing a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, a total of 5002 adult patients with AF were enrolled for analysis. We performed an unsupervised hierarchical cluster analysis based on CHA2DS2-VASc score after model assessment. The risk of transient ischemia accident (TIA)/ischemic stroke, heart failure (HF) hospitalization, cardiovascular mortality, and all-cause mortality were assessed.
Results: We identified four replicable distinct clusters of patients with AF: cluster I included diabetic patients with HF with preserved ejection fraction and chronic kidney disease; cluster II included elder patients with a low BMI and pulmonary hypertension; cluster III included patients with metabolic syndrome and atherosclerotic disease; and cluster IV included patients with left heart dysfunction including reduced ejection fraction and enlarged left atrium. The incidence of stroke were 12.7%, 15.1%, 9.9%, and 6.3% in clusters I to IV respectively. Cox regression analyses showed that the differences in risk of TIA/ischemic stroke risk across clusters (cluster I, II, III vs. IV) were statistically significant (Hazard ratio (HR) 1.87 [95% CI 1.00–3.48], 2.06 [95% CI 1.06–4.01], 1.70 [95% CI 1.02–2.84]). Cluster II was independently associated with highest risk for stroke (HR 2.06 [1.06-4.01]), HF hospitalization (HR 1.19 [95% CI 0.79-1.80]), cardiac death (HR 2.51 [95% CI 1.21-5.22]), and all-cause death (HR 2.98 [95% CI 1.98-4.50]).
Conclusion: We found a data-driven algorithm identifying clusters with unique phenotype and different risks of cardiovascular outcomes in patients with AF after accounting for CHA2DS2-VASc risk scores.
Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors
Declaration of Interests: None.
Ethics Approval Statement: The study protocol complies with the Declaration of Helsinki and was approved by the Institutional Review Board of National Taiwan University Hospital.
Suggested Citation: Suggested Citation