TY - JOUR
T1 - Phenotyping of Elderly Patients With Heart Failure Focused on Noncardiac Conditions
T2 - A Latent Class Analysis From a Multicenter Registry of Patients Hospitalized With Heart Failure
AU - Nakamaru, Ryo
AU - Shiraishi, Yasuyuki
AU - Niimi, Nozomi
AU - Kohno, Takashi
AU - Nagatomo, Yuji
AU - Takei, Makoto
AU - Ikoma, Takenori
AU - Nishikawa, Kei
AU - Sakamoto, Munehisa
AU - Nakano, Shintaro
AU - Kohsaka, Shun
AU - Yoshikawa, Tsutomu
N1 - Funding Information:
This study was supported by a Grant-in-Aid for Young Scientists (Japan Society for the Promotion of Science [KAKANHI] 18K15860), a Grant-in-Aid for Scientific Research (KAKENHI 21K08142, 21K08064, 20K08408, 18K08056, 17K09526, 16KK0186, and 16H05215), a Health Labour Sciences Research Grant (14528506), the Sakakibara Clinical Research Grant for Promotion of Sciences (2012 to 2020), and a grant from the Japan Agency for Medical Research and Development (201439013C).
Funding Information:
The authors are grateful to the investigators of the WET-HF. The English language editing (Editage, https://www.editage.jp) and article processing charge in this study were supported by a Grant-in-Aid for Young Scientists (Japan Society for the Promotion of Science KAKENHI; 22K16067).
Funding Information:
Dr Shiraishi is affiliated with an endowed department by Nippon Shinyaku, Medtronic Japan, and BIOTRONIK JAPAN. Dr Shiraishi also received research grants from the SECOM Science and Technology Foundation and the Uehara Memorial Foundation, and honoraria from Otsuka Pharmaceutical and Ono Pharmaceutical. Dr Kohsaka received an unrestricted research grant from Novartis Pharmaceutical and honoraria from Bristol-Myer Squibb. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2023/2/7
Y1 - 2023/2/7
N2 - BACKGROUND: The burden of noncardiovascular conditions is becoming increasingly prevalent in patients with heart failure (HF). We aimed to identify novel phenogroups incorporating noncardiovascular conditions to facilitate understanding and risk stratification in elderly patients with HF. METHODS AND RESULTS: Data from a total of 1881 (61.2%) patients aged ≥65 years were extracted from a prospective multicenter registry of patients hospitalized for acute HF (N=3072). We constructed subgroups of patients with HF with preserved ejection fraction (HFpEF; N=826, 43.9%) and those with non-HFpEF (N=1055, 56.1%). Latent class analysis was performed in each subgroup using 17 variables focused on noncardiovascular conditions (including comorbidities, Clinical Frailty Scale, and Geriatric Nutritional Risk Index). The latent class analysis revealed 3 distinct clinical phenogroups in both HFpEF and non-HFpEF subgroups: (1) robust physical and nutritional status (Group 1: HFpEF, 41.2%; non-HFpEF, 46.0%); (2) multimorbid patients with renal impairment (Group 2: HFpEF, 40.8%; non-HFpEF, 41.9%); and (3) malnourished patients (Group 3: HFpEF, 18.0%; non-HFpEF, 12.1%). After multivariable adjustment, compared with Group 1, patients in Groups 2 and 3 had a higher risk for all-cause death over the 1-year postdischarge period (hazard ratio [HR], 2.79 [95% CI, 1.64–4.81] and HR, 2.73 [95% CI, 1.39–5.35] in HFpEF; HR, 1.96 [95% CI, 1.22–3.14] and HR, 2.97 [95% CI, 1.64–5.38] in non-HFpEF; respectively). CONCLUSIONS: In elderly patients with HF, the phenomapping focused on incorporating noncardiovascular conditions identified 3 phenogroups, each representing distinct clinical outcomes, and the discrimination pattern was similar for both patients with HFpEF and non-HFpEF. This classification provides novel risk stratification and may aid in clinical decision making.
AB - BACKGROUND: The burden of noncardiovascular conditions is becoming increasingly prevalent in patients with heart failure (HF). We aimed to identify novel phenogroups incorporating noncardiovascular conditions to facilitate understanding and risk stratification in elderly patients with HF. METHODS AND RESULTS: Data from a total of 1881 (61.2%) patients aged ≥65 years were extracted from a prospective multicenter registry of patients hospitalized for acute HF (N=3072). We constructed subgroups of patients with HF with preserved ejection fraction (HFpEF; N=826, 43.9%) and those with non-HFpEF (N=1055, 56.1%). Latent class analysis was performed in each subgroup using 17 variables focused on noncardiovascular conditions (including comorbidities, Clinical Frailty Scale, and Geriatric Nutritional Risk Index). The latent class analysis revealed 3 distinct clinical phenogroups in both HFpEF and non-HFpEF subgroups: (1) robust physical and nutritional status (Group 1: HFpEF, 41.2%; non-HFpEF, 46.0%); (2) multimorbid patients with renal impairment (Group 2: HFpEF, 40.8%; non-HFpEF, 41.9%); and (3) malnourished patients (Group 3: HFpEF, 18.0%; non-HFpEF, 12.1%). After multivariable adjustment, compared with Group 1, patients in Groups 2 and 3 had a higher risk for all-cause death over the 1-year postdischarge period (hazard ratio [HR], 2.79 [95% CI, 1.64–4.81] and HR, 2.73 [95% CI, 1.39–5.35] in HFpEF; HR, 1.96 [95% CI, 1.22–3.14] and HR, 2.97 [95% CI, 1.64–5.38] in non-HFpEF; respectively). CONCLUSIONS: In elderly patients with HF, the phenomapping focused on incorporating noncardiovascular conditions identified 3 phenogroups, each representing distinct clinical outcomes, and the discrimination pattern was similar for both patients with HFpEF and non-HFpEF. This classification provides novel risk stratification and may aid in clinical decision making.
KW - elderly patients
KW - heart failure
KW - noncardiovascular conditions
KW - phenotyping
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U2 - 10.1161/JAHA.122.027689
DO - 10.1161/JAHA.122.027689
M3 - Article
C2 - 36695300
AN - SCOPUS:85147536141
SN - 2047-9980
VL - 12
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 3
M1 - e027689
ER -
