Key result
Clinical phenotypes of atrial fibrillation were associated with progressive mortality risk, peaking in older patients with previous cerebrovascular events (aHR 8.927; 95% CI 3.238-24.605; P<0.001).
Why the study?
Patients with AF continue to experience high mortality despite optimal antithrombotic treatment, prompting the need to identify clinical phenotypes to stratify mortality risk.
Cohort (n=5,171)
Yes
Cluster analysis of atrial fibrillation patients identifies four distinct clinical phenotypes with progressively increasing mortality risk, highlighting the importance of comorbidity-based risk stratification.
AF comorbidity clusters stratify mortality risk; hypothesis-generating and requires prospective validation before guiding care.
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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Pastori et al. (2022) conducted a cohort in Atrial fibrillation (n=5,171). Clinical phenotype Cluster 4 (oldest patients, mainly women, previous cerebrovascular events) vs. Cluster 1 (youngest patients, low comorbidities) was evaluated on All-cause mortality (aHR 8.927, 95% CI 3.238-24.605, p=< 0.001). Clinical phenotypes of atrial fibrillation were associated with progressive mortality risk, peaking in older patients with previous cerebrovascular events (aHR 8.927; 95% CI 3.238-24.605; P<0.001).
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