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October 23, 2025Frontiers in Cardiovascular MedicineOpen Access

From patterns to prognosis: machine learning–derived clusters in advanced heart failure

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Why the study?

Advanced heart failure is clinically heterogeneous with poor prognosis, and traditional classification systems often fail to capture the complexity required for personalized care.

Population

524 patients with advanced HF undergoing comprehensive clinical, echocardiographic, hemodynamic, and cardiopulmonary assessments

Design

Retrospective cohort study

Follow-up

Median of 2.4 years

Key result

The machine learning-derived adverse profile cluster (Cluster 2) was associated with a 3.84-fold increased risk of mortality, LVAD implantation, or heart transplantation compared to Cluster 1.

Authors

MKMurat KaraçamBKBarkın KültürsayDMDeniz Mutlu

Discussion

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Member takes

Overview

Should not yet guide HF management; hypothesis-generating for ML phenotyping and requires prospective validation.

Study Design

Type

Cohort (n=524)

Multicenter

No

Structured PICO

P
Population
524 patients with advanced heart failure (NYHA class III-IV, LVEF ≤25%, persistent severe symptoms despite optimal medical therapy), median age 53, 85.3% male, evaluated at a tertiary cardiovascular center.
O
Outcome
Composite of all-cause mortality, left ventricular assist device (LVAD) implantation, or heart transplantationcomposite

Main Result

Effect estimate: HR 3.84 (95% CI 2.72-5.43)

Absolute Event Rate: 50% vs 15.6%

p-value: p=<0.001

Limitations

  • Modest sample size
  • Predominantly male cohort limits generalizability to female patients
  • Retrospective and observational design precludes causal inference
  • Single-center experience limits external validity and generalizability
  • Binary clinical variables were excluded from the clustering input

Cite This Study

Karaçam et al. (2025) conducted a cohort in Advanced heart failure (n=524). Cluster 2 (Adverse Profile Cluster) vs. Cluster 1 (Favorable Profile Cluster) was evaluated on Composite of all-cause mortality, LVAD implantation, or heart transplantation (HR 3.84, 95% CI 2.72-5.43, p=<0.001). The machine learning-derived adverse profile cluster (Cluster 2) was associated with a 3.84-fold increased risk of mortality, LVAD implantation, or heart transplantation compared to Cluster 1.

synapsesocial.com/papers/6a0ecaada14f152feaf9d8d6https://doi.org/10.3389/fcvm.2025.1669538
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Multimorbidity in Heart Failure: Leveraging Cluster Analysis to Guide Tailored Treatment Strategies2023 · 18 citations
  2. 2Machine Learning Methods Improve Prognostication, Identify Clinically Distinct Phenotypes, and Detect Heterogeneity in Response to Therapy in a Large Cohort of Heart Failure Patients2018 · 252 citations
  3. 3Exploring and Identifying Prognostic Phenotypes of Patients with Heart Failure Guided by Explainable Machine Learning2022 · 12 citations
  4. 4Predicting need for heart failure advanced therapies using an interpretable tropical geometry-based fuzzy neural network2023 · 4 citations
  5. 5Phenomapping in heart failure with preserved ejection fraction: insights, limitations, and future directions2022 · 87 citations