Clinical phenotype classification to predict risk and optimize the management of patients with atrial fibrillation using the Atrial Fibrillation Better Care (ABC) pathway: a report from the COOL-AF registry
Issued Date
2024-01-01
Resource Type
ISSN
14602725
eISSN
14602393
Scopus ID
2-s2.0-85184582393
Pubmed ID
37788118
Journal Title
QJM: An International Journal of Medicine
Volume
117
Issue
1
Start Page
16
End Page
23
Rights Holder(s)
SCOPUS
Bibliographic Citation
QJM: An International Journal of Medicine Vol.117 No.1 (2024) , 16-23
Suggested Citation
Krittayaphong R., Treewaree S., Wongtheptien W., Kaewkumdee P., Lip G.Y.H. Clinical phenotype classification to predict risk and optimize the management of patients with atrial fibrillation using the Atrial Fibrillation Better Care (ABC) pathway: a report from the COOL-AF registry. QJM: An International Journal of Medicine Vol.117 No.1 (2024) , 16-23. 23. doi:10.1093/qjmed/hcad219 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/97229
Title
Clinical phenotype classification to predict risk and optimize the management of patients with atrial fibrillation using the Atrial Fibrillation Better Care (ABC) pathway: a report from the COOL-AF registry
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Phenotypic classification is a method of grouping patients with similar phenotypes. Aim: We aimed to use phenotype classification based on a clustering process for risk stratification of patients with non-valvular atrial fibrillation (AF) and second, to assess the benefit of the Atrial Fibrillation Better Care (ABC) pathway. Methods: Patients with AF were prospectively enrolled from 27 hospitals in Thailand from 2014 to 2017, and followed up every 6 months for 3 years. Cluster analysis was performed from 46 variables using the hierarchical clustering using the Ward minimum variance method. Outcomes were a composite of all-cause death, ischemic stroke/systemic embolism, acute myocardial infarction and heart failure. Results: A total of 3405 patients were enrolled (mean age 67.8 ± 11.3 years, 58.2% male). During the mean follow-up of 31.8 ± 8.7 months. Three clusters were identified: Cluster 1 had the highest risk followed by Cluster 3 and Cluster 2 with a hazard ratio (HR) and 95% confidence interval (CI) of composite outcomes of 2.78 (2.25, 3.43), P < 0.001 for Cluster 1 and 1.99 (1.63, 2.42), P < 0.001 for Cluster 3 compared with Cluster 2. Management according to the ABC pathway was associated with reductions in adverse clinical outcomes especially those who belonged to Clusters 1 and 3 with HR and 95%CI of the composite outcome of 0.54 (0.40, 073), P < 0.001 for Cluster 1 and 0.49 (0.38, 0.63), P < 0.001 for Cluster 3. Conclusion: Phenotypic classification helps in risk stratification and prognostication. Compliance with the ABC pathway was associated with improved clinical outcomes.