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

Marco Proietti; Marco Vitolo; Stephanie L Harrison; Deirdre A Lane; Laurent Fauchier; Francisco Marin; Michael Nabauer; Tatjana S Potpara; Gheorghe-Andrei Dan; Giuseppe Boriani; Gregory Y H Lip; the ESC-EHRA EORP-AF Long-Term General Registry Investigators

doi:10.1186/s12916-021-02120-3

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

Marco Proietti, Marco Vitolo, Stephanie L Harrison, Deirdre A Lane, Laurent Fauchier, Francisco Marin, Michael Nabauer, Tatjana S Potpara, Gheorghe-Andrei Dan, Giuseppe Boriani, Gregory Y H Lip, the ESC-EHRA EORP-AF Long-Term General Registry Investigators

Research output: Contribution to journal › Article › peer-review

42 Citations (Scopus)

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Abstract

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.

Original language	English
Article number	256
Number of pages	17
Journal	BMC Medicine
Volume	19
Issue number	1
Early online date	20 Oct 2021
DOIs	https://doi.org/10.1186/s12916-021-02120-3
Publication status	Published - Dec 2021
Externally published	Yes

Keywords

Atrial fibrillation
Clinical management
Clinical phenotypes
Cluster analysis
Major adverse outcomes

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Proietti, M., Vitolo, M., Harrison, S. L., Lane, D. A., Fauchier, L., Marin, F., Nabauer, M., Potpara, T. S., Dan, G.-A., Boriani, G., Lip, G. Y. H., & the ESC-EHRA EORP-AF Long-Term General Registry Investigators (2021). 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. BMC Medicine, 19(1), Article 256. https://doi.org/10.1186/s12916-021-02120-3

@article{b437ad5603bd4848b4a030d0984fbd12,

title = "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",

abstract = "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{\textquoteright} clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward{\textquoteright}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{\textquoteright} 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.",

keywords = "Atrial fibrillation, Clinical management, Clinical phenotypes, Cluster analysis, Major adverse outcomes",

author = "Marco Proietti and Marco Vitolo and Harrison, {Stephanie L} and Lane, {Deirdre A} and Laurent Fauchier and Francisco Marin and Michael Nabauer and Potpara, {Tatjana S} and Gheorghe-Andrei Dan and Giuseppe Boriani and Lip, {Gregory Y H} and {the ESC-EHRA EORP-AF Long-Term General Registry Investigators} and G. Qoriani and L. Tavazzi and Maggioni, {A. P.} and M. Nabauer and Z. Kalarus and R. Ferrari and A. Shantsila and A. Goda and G. Mairesse and T. Shalganov and L. Antoniades and M. Taborsky and S. Riahi and P. Muda and {Garc{\'i}a Bolao}, I. and O. Piot and M. Nabauer and K. Etsadashvili and Simantirakis, {E. N.} and M. Haim and A. Azhari and J. Najafian and M. Santini and E. Mirrakhimov and K. Kulzida and A. Erglis and L. Poposka and Burg, {M. R.} and Crijns, {H. J.G.M.} and Erk{\"u}ner and D. Atar and R. Lenarczyk and {Martins Oliveira}, M. and D. Shah and Dan, {G. A.} and E. Serdechnaya and E. Diker and U. Ekmek{\c c}iu and V. Paparisto and E. Z{\"e}ra and H. Gjergo and J. Dragoti and A. Goda and M. Ciutea and N. Ahadi and {el Husseini}, Z. and M. Raepers and J. Leroy and P. Haushan and A. Jourdan and C. Lepiece and L. Desteghe and J. Vijgen and P. Koopman and {Van Genechten}, G. and H. Heidbuchel and T. Boussy and {De Coninck}, M. and {Van Eeckhoutte}, H. and N. Bouckaert and A. Friart and J. Boreux and C. Arend and P. Evrard and L. Stefan and E. Hoffer and J. Herzet and M. Massoz and C. Celentano and M. Sprynger and L. Pierard and P. Melon and {Van Hauwaert}, B. and C. Kuppens and D. Faes and {Van Lier}, D. and {Van Dorpe}, A. and A. Gerardy and O. Deceuninck and O. Xhaet and F. Dormal and E. Ballant and D. Blommaert and D. Yakova and M. Hristov and T. Yncheva and N. Stancheva and S. Tisheva and M. Tokmakova and F. Nikolov and D. Gencheva and B. Kunev and M. Stoyanov and D. Marchov and V. Gelev and V. Traykov and A. Kisheva and H. Tsvyatkov and R. Shtereva and S. Bakalska-Georgieva and S. Slavcheva and Y. Yotov and M. Kub{\'i}{\v c}kov{\'a} and {Marni Joensen}, A. and A. Gammelmark and {Hvilsted Rasmussen}, L. and P. Dinesen and {Krogh Ven{\o}}, S. and B. Sorensen and A. Korsgaard and K. Andersen and {Fragtrup Hellum}, C. and A. Svenningsen and O. Nyvad and P. Wiggers and O. May and A. Aarup and B. Graversen and L. Jensen and M. Andersen and M. Svejgaard and S. Vester and S. Hansen and V. Lynggaard and M. Ciudad and R. Vettus and P. Muda and A. Maestre and S. Casta{\~n}o and S. Cheggour and J. Poulard and V. Mouquet and S. Leparr{\'e}e and J. Bouet and J. Taieb and A. Doucy and H. Duquenne and A. Furber and J. Dupuis and J. Rautureau and M. Font and P. Damiano and M. Lacrimini and J. Abalea and S. Boismal and T. Menez and J. Mansourati and G. Range and H. Gorka and C. Laure and C. Vassali{\`e}re and N. Elbaz and N. Lellouche and K. Djouadi and F. Roubille and D. Dietz and J. Davy and M. Granier and P. Winum and C. Leperchois-Jacquey and H. Kassim and E. Marijon and {Le Heuzey}, J. and J. Fedida and C. Maupain and C. Himbert and E. Gandjbakhch and F. Hidden-Lucet and G. Duthoit and N. Badenco and T. Chastre and X. Waintraub and M. Oudihat and J. Lacoste and C. Stephan and H. Bader and N. Delarche and L. Giry and D. Arnaud and C. Lopez and F. Boury and I. Brunello and M. Lef{\`e}vre and R. Mingam and M. Haissaguerre and {Le Bidan}, M. and K. Schmitz and A. Beer and S. Walter and M. Arnold and A. Baumer and K. Winter and M. Stasiak and J. Hunt and R. Brown and J. McDonald and K. Davies and J. Brown and K. Jones and L. Buchanan and T. Wilson and E. Young and J. Law and H. Thomas and J. Fuller and A. Sharp and K. Thorpe and C. Mills and A. Wilson and M. Robinson and S. Ryan and E. Gibson and D. Leonard and J. Hill and L. Reid and M. George and J. Muir and N. Andrews and C. Turner and A. Wood and L. Evans and L. Williams and L. Bell and J. Brown and L. Frost and M. Adams and C. Miller and C. Brown and D. McKenzie and K. Roberts and D. Hughes and M. Khan and R. Jones and E. Radford and S. Milgate and C. Buckley and D. Wood",

year = "2021",

month = dec,

doi = "10.1186/s12916-021-02120-3",

language = "English",

volume = "19",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BioMed Central Ltd.",

number = "1",

}

Proietti, M, Vitolo, M, Harrison, SL, Lane, DA, Fauchier, L, Marin, F, Nabauer, M, Potpara, TS, Dan, G-A, Boriani, G, Lip, GYH & the ESC-EHRA EORP-AF Long-Term General Registry Investigators 2021, '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', BMC Medicine, vol. 19, no. 1, 256. https://doi.org/10.1186/s12916-021-02120-3

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. / Proietti, Marco; Vitolo, Marco; Harrison, Stephanie L et al.
In: BMC Medicine, Vol. 19, No. 1, 256, 12.2021.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients

T2 - A report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

AU - Proietti, Marco

AU - Vitolo, Marco

AU - Harrison, Stephanie L

AU - Lane, Deirdre A

AU - Fauchier, Laurent

AU - Marin, Francisco

AU - Nabauer, Michael

AU - Potpara, Tatjana S

AU - Dan, Gheorghe-Andrei

AU - Boriani, Giuseppe

AU - Lip, Gregory Y H

AU - the ESC-EHRA EORP-AF Long-Term General Registry Investigators

AU - Qoriani, G.

AU - Tavazzi, L.

AU - Maggioni, A. P.

AU - Nabauer, M.

AU - Kalarus, Z.

AU - Ferrari, R.

AU - Shantsila, A.

AU - Goda, A.

AU - Mairesse, G.

AU - Shalganov, T.

AU - Antoniades, L.

AU - Taborsky, M.

AU - Riahi, S.

AU - Muda, P.

AU - García Bolao, I.

AU - Piot, O.

AU - Nabauer, M.

AU - Etsadashvili, K.

AU - Simantirakis, E. N.

AU - Haim, M.

AU - Azhari, A.

AU - Najafian, J.

AU - Santini, M.

AU - Mirrakhimov, E.

AU - Kulzida, K.

AU - Erglis, A.

AU - Poposka, L.

AU - Burg, M. R.

AU - Crijns, H. J.G.M.

AU - Erküner,

AU - Atar, D.

AU - Lenarczyk, R.

AU - Martins Oliveira, M.

AU - Shah, D.

AU - Dan, G. A.

AU - Serdechnaya, E.

AU - Diker, E.

AU - Ekmekçiu, U.

AU - Paparisto, V.

AU - Zëra, E.

AU - Gjergo, H.

AU - Dragoti, J.

AU - Goda, A.

AU - Ciutea, M.

AU - Ahadi, N.

AU - el Husseini, Z.

AU - Raepers, M.

AU - Leroy, J.

AU - Haushan, P.

AU - Jourdan, A.

AU - Lepiece, C.

AU - Desteghe, L.

AU - Vijgen, J.

AU - Koopman, P.

AU - Van Genechten, G.

AU - Heidbuchel, H.

AU - Boussy, T.

AU - De Coninck, M.

AU - Van Eeckhoutte, H.

AU - Bouckaert, N.

AU - Friart, A.

AU - Boreux, J.

AU - Arend, C.

AU - Evrard, P.

AU - Stefan, L.

AU - Hoffer, E.

AU - Herzet, J.

AU - Massoz, M.

AU - Celentano, C.

AU - Sprynger, M.

AU - Pierard, L.

AU - Melon, P.

AU - Van Hauwaert, B.

AU - Kuppens, C.

AU - Faes, D.

AU - Van Lier, D.

AU - Van Dorpe, A.

AU - Gerardy, A.

AU - Deceuninck, O.

AU - Xhaet, O.

AU - Dormal, F.

AU - Ballant, E.

AU - Blommaert, D.

AU - Yakova, D.

AU - Hristov, M.

AU - Yncheva, T.

AU - Stancheva, N.

AU - Tisheva, S.

AU - Tokmakova, M.

AU - Nikolov, F.

AU - Gencheva, D.

AU - Kunev, B.

AU - Stoyanov, M.

AU - Marchov, D.

AU - Gelev, V.

AU - Traykov, V.

AU - Kisheva, A.

AU - Tsvyatkov, H.

AU - Shtereva, R.

AU - Bakalska-Georgieva, S.

AU - Slavcheva, S.

AU - Yotov, Y.

AU - Kubíčková, M.

AU - Marni Joensen, A.

AU - Gammelmark, A.

AU - Hvilsted Rasmussen, L.

AU - Dinesen, P.

AU - Krogh Venø, S.

AU - Sorensen, B.

AU - Korsgaard, A.

AU - Andersen, K.

AU - Fragtrup Hellum, C.

AU - Svenningsen, A.

AU - Nyvad, O.

AU - Wiggers, P.

AU - May, O.

AU - Aarup, A.

AU - Graversen, B.

AU - Jensen, L.

AU - Andersen, M.

AU - Svejgaard, M.

AU - Vester, S.

AU - Hansen, S.

AU - Lynggaard, V.

AU - Ciudad, M.

AU - Vettus, R.

AU - Muda, P.

AU - Maestre, A.

AU - Castaño, S.

AU - Cheggour, S.

AU - Poulard, J.

AU - Mouquet, V.

AU - Leparrée, S.

AU - Bouet, J.

AU - Taieb, J.

AU - Doucy, A.

AU - Duquenne, H.

AU - Furber, A.

AU - Dupuis, J.

AU - Rautureau, J.

AU - Font, M.

AU - Damiano, P.

AU - Lacrimini, M.

AU - Abalea, J.

AU - Boismal, S.

AU - Menez, T.

AU - Mansourati, J.

AU - Range, G.

AU - Gorka, H.

AU - Laure, C.

AU - Vassalière, C.

AU - Elbaz, N.

AU - Lellouche, N.

AU - Djouadi, K.

AU - Roubille, F.

AU - Dietz, D.

AU - Davy, J.

AU - Granier, M.

AU - Winum, P.

AU - Leperchois-Jacquey, C.

AU - Kassim, H.

AU - Marijon, E.

AU - Le Heuzey, J.

AU - Fedida, J.

AU - Maupain, C.

AU - Himbert, C.

AU - Gandjbakhch, E.

AU - Hidden-Lucet, F.

AU - Duthoit, G.

AU - Badenco, N.

AU - Chastre, T.

AU - Waintraub, X.

AU - Oudihat, M.

AU - Lacoste, J.

AU - Stephan, C.

AU - Bader, H.

AU - Delarche, N.

AU - Giry, L.

AU - Arnaud, D.

AU - Lopez, C.

AU - Boury, F.

AU - Brunello, I.

AU - Lefèvre, M.

AU - Mingam, R.

AU - Haissaguerre, M.

AU - Le Bidan, M.

AU - Schmitz, K.

AU - Beer, A.

AU - Walter, S.

AU - Arnold, M.

AU - Baumer, A.

AU - Winter, K.

AU - Stasiak, M.

AU - Hunt, J.

AU - Brown, R.

AU - McDonald, J.

AU - Davies, K.

AU - Brown, J.

AU - Jones, K.

AU - Buchanan, L.

AU - Wilson, T.

AU - Young, E.

AU - Law, J.

AU - Thomas, H.

AU - Fuller, J.

AU - Sharp, A.

AU - Thorpe, K.

AU - Mills, C.

AU - Wilson, A.

AU - Robinson, M.

AU - Ryan, S.

AU - Gibson, E.

AU - Leonard, D.

AU - Hill, J.

AU - Reid, L.

AU - George, M.

AU - Muir, J.

AU - Andrews, N.

AU - Turner, C.

AU - Wood, A.

AU - Evans, L.

AU - Williams, L.

AU - Bell, L.

AU - Brown, J.

AU - Frost, L.

AU - Adams, M.

AU - Miller, C.

AU - Brown, C.

AU - McKenzie, D.

AU - Roberts, K.

AU - Hughes, D.

AU - Khan, M.

AU - Jones, R.

AU - Radford, E.

AU - Milgate, S.

AU - Buckley, C.

AU - Wood, D.

PY - 2021/12

Y1 - 2021/12

N2 - 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.

AB - 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.

KW - Atrial fibrillation

KW - Clinical management

KW - Clinical phenotypes

KW - Cluster analysis

KW - Major adverse outcomes

UR - http://www.scopus.com/inward/record.url?scp=85117929197&partnerID=8YFLogxK

U2 - 10.1186/s12916-021-02120-3

DO - 10.1186/s12916-021-02120-3

M3 - Article

C2 - 34666757

AN - SCOPUS:85117929197

SN - 1741-7015

VL - 19

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 256

ER -

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

Abstract

Keywords

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