Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

著者: Marco Proietti, Marco Vitolo, Stephanie L. Harrison, Deirdre A. Lane, Laurent Fauchier, Francisco Marin, Michael Näbauer, Tatjana Potpara, Gheorghe-Andrei Dan, Giuseppe Boriani, Gregory Y. H. Lip, on behalf of the ESC-EHRA EORP-AF Long-Term General Registry Investigators, Giuseppe Boriani, G. Y. H. Lip, Luigi Tavazzi, A. P. Maggioni, G.-A. Dan, T. Potpara, M. Nabauer, Francisco Marı́n, Z. Kalarus, L. Fauchier, R. Ferrari, Alena Shantsila, Artan Goda, Georges H. Mairesse, T. Shalganov, Loizos Antoniades, Miloš Táborský, S. Riahi, P. Muda, I. García Bolao, O. Piot, M. Nabauer, K. Etsadashvili, Εmmanuel Simantirakis, Moti Haim, Amirhossein Azhari, Jamshid Najafian, Massimo Santini, E. Mirrakhimov, K a Kulzida, A. Erglis, L. Poposka, M Burg, H. Crijns, Ö. Erküner, D. Atar, Radosław Lenarczyk, Mário Oliveira, D. Shah, G.-A. Dan, E. Serdechnaya, T. Potpara, E. Diker, G. Y. H. Lip, D. Lane, E Zëra, U. Ekmekçiu, Vilma Paparisto, Mihal Tase, H. Gjergo, J Dragoti, A. Goda, M Ciutea, N. Ahadi, Z. el Husseini, M. Raepers, J. Leroy, P. Haushan, A Jourdan, Caroline Lepièce, L. Desteghe, J. Vijgen, P. Koopman, G. Van Genechten, Hein Heidbüchel, Tim Boussy, M De Coninck, Hannelore Van Eeckhoutte, N Bouckaert, A. Friart, J. Boreux, C Arend, P. Evrard, L. Stefan, E Hoffer, J. Herzet, M Massoz, C. Celentano, Muriel Sprynger, L. Pierard, P Mélon, B. Van Hauwaert, C. Kuppens, Dirk Faes, Dirk van Lier, A. Van Dorpe, A. Gerardy, O. Deceuninck, Olivier Xhaët, Fabien Dormal, Elisabeth Ballant, D. Blommaert, D. Yakova, M. Hristov, T Yncheva, N. Stancheva, S. Tisheva, Mariya Tokmakova, F. Nikolov, D Gencheva, T. Shalganov, B. Kunev, M. Stoyanov, D. Marchov, V. Gelev, Vassil Traykov, Аntoniya Kisheva, H. Tsvyatkov, R. Shtereva, S. Bakalska-Georgieva, S Slavcheva, Yoto Yotov, Milena Kubíčková, A Marni Joensen, Anders Gammelmark, Lars Hvilsted Rasmussen, P. Dinesen, S. Riahi, Stine Krogh Venø, Birgit Sørensen, A. Korsgaard, K. Andersen, Camilla Fragtrup Hellum, A. 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Alam, Monique Robinson, Sarah Ryan, R Egdell, E. Gibson, M. Holland, David Léonard, B. Mishra, S. Ahmad, H. Randall, Julia Hill, Lynne Reid, M. George, S. McKinley, L. Brockway, William Milligan, J. Sobolewska, James Muir, L. Tuckis, L Winstanley, Pradeep Jacob, S Kaye, L Morby, A. Jan, T. Sewell, Christopher J. Boos, B. Wadams, Constantin Cope, P. Jefferey, Noah Andrews, Allyson K. Getty, Anne Suttling, C. Turner, Kathleen Hudson, R. Austin, S. Howe, Rabia Iqbal, N. Gandhi, K Brophy, P. Mirza, E Willard, S Collins, Ntokozo Ndlovu, E. Subkovas, V. Karthikeyan, L. Waggett, Amanda Wood, A Bolger, J. Stockport, L. Evans, Ece Harman, Jennifer Starling, L. Williams, V. Saul, Michael S. Sinha, L. Bell, S. Tudgay, S. Kemp, J. Brown, Lars Frost, T Ingram, Anita M. Loughlin, Casey Adams, M. Adams, F Hurford, C. Owen, Chris Miller, Denise Donaldson, H. Tivenan, H. Button, A Nasser, O. Jhagra, B Stidolph, C Brown, Churchill Livingstone, M. Duffy, P Madgwick, P. Roberts, E. Greenwood, L Fletcher, M. Beveridge, S Earles, David McKenzie, D. Beacock, Mark Dayer, Mike Seddon, D Greenwell, F Luxton, F Venn, Harold Mills, J Rewbury, Karen James, K Roberts, Louise Tonks, D Felmeden, W. Taggu, A Summerhayes, David M. Hughes, J Sutton, L Felmeden, Mohammad Khan, E Walker, L Norris, L O’Donohoe, Abdul Mozid, Harvey Dymond, Hannah Lloyd-Jones, G. Saunders, David N. Simmons, D. R. Coles, Donna Cotterill, S Beech, Stephen Kidd, Benjamin Wrigley, Sanjiv Petkar, Andrew Smallwood, Robert Jones, E Radford, Sarah Milgate, Stella Metherell, V Cottam, C Buckley, A Broadley, D Wood, John D. Allison, Kirsten L. Rennie, L. Balian, Luke Howard, L Pippard, S. Board, T Pitt-Kerby - BMC Medicine 2021 被引用: 53

BACKGROUND: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients' clinical phenotypes and analyse the differential clinical course. METHODS: We performed a hierarchical cluster analysis based on Ward's Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. RESULTS: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients' prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P < .001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27-3.62; HR 3.42, 95%CI 2.72-4.31; HR 2.79, 95%CI 2.32-3.35), and Cluster 1 (HR 1.88, 95%CI 1.48-2.38; HR 2.50, 95%CI 1.98-3.15; HR 2.09, 95%CI 1.74-2.51) reported a higher risk for the three outcomes respectively. CONCLUSIONS: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes.