Phenotypes of South Asian patients with atrial fibrillation and holistic integrated care management: cluster analysis of data from KERALA-AF Registry

Chen, Y ORCID: 0000-0002-2808-6286, Huang, B, Calvert, P, Liu, Y, Gue, Y, Gupta, D, McDowell, G ORCID: 0000-0002-2880-5236, Azariah, JL, Namboodiri, N ORCID: 0000-0001-7997-1333, Unni, G, Balagopalan, JP ORCID: 0000-0002-7071-2447, Lip, GYH ORCID: 0000-0002-7566-1626, Gopalan, BC ORCID: 0000-0001-6245-3994, Jabir, A, George Koshy, A, Zachariah, G, Shifas Babu, M, Venugopal, K, Punnose, E, Natarajan, KU et al (2024) Phenotypes of South Asian patients with atrial fibrillation and holistic integrated care management: cluster analysis of data from KERALA-AF Registry. The Lancet Regional Health - Southeast Asia, 31. ISSN 2772-3682

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Abstract

Background: Patients with atrial fibrillation (AF) frequently experience multimorbidity. Cluster analysis, a machine learning method for classifying patients with similar phenotypes, has not yet been used in South Asian AF patients. Methods: The Kerala Atrial Fibrillation Registry is a prospective multicentre cohort study in Kerala, India, and the largest prospective AF registry in South Asia. Hierarchical clustering was used to identify different phenotypic clusters. Outcomes were all-cause mortality, major adverse cardiovascular events (MACE), and composite bleeding events within one-year follow-up. Findings: 3348 patients were included (median age 65.0 [56.0–74.0] years; 48.8% male; median CHA2DS2-VASc 3.0 [2.0–4.0]). Five clusters were identified. Cluster 1: patients aged ≤65 years with rheumatic conditions; Cluster 2: patients aged >65 years with multi-comorbidities, suggestive of cardiovascular-kidney-metabolic syndrome; Cluster 3: patients aged ≤65 years with fewer comorbidities; Cluster 4: heart failure patients with multiple comorbidities; Cluster 5: male patients with lifestyle-related risk factors. Cluster 1, 2 and 4 had significantly higher MACE risk compared to Cluster 3 (Cluster 1: OR 1.36, 95% CI 1.08–1.71; Cluster 2: OR 1.79, 95% CI 1.42–2.25; Cluster 4: OR 1.76, 95% CI 1.31–2.36). The results for other outcomes were similar. Atrial fibrillation Better Care (ABC) pathway in the whole cohort was low (10.1%), especially in Cluster 4 (1.9%). Overall adherence to the ABC pathway was associated with reduced all-cause mortality (OR 0.26, 95% CI 0.15–0.46) and MACE (OR 0.45, 95% CI 0.31–0.46), similar trends were evident in different clusters. Interpretation: Cluster analysis identified distinct phenotypes with implications for outcomes. There was poor ABC pathway adherence overall, but adherence to such integrated care was associated with improved outcomes. Funding: Kerala Chapter of Cardiological Society of India.

Item Type:	Article
Uncontrolled Keywords:	Cardiovascular; Clinical Research; Heart Disease; 2.4 Surveillance and distribution; 4.2 Evaluation of markers and technologies; Cardiovascular; 3 Good Health and Well Being
Subjects:	Q Science > QH Natural history > QH301 Biology R Medicine > R Medicine (General)
Divisions:	Pharmacy and Biomolecular Sciences
Publisher:	Elsevier
Date of acceptance:	25 October 2024
Date of first compliant Open Access:	3 December 2024
Date Deposited:	03 Dec 2024 12:27
Last Modified:	03 Jul 2025 17:15
DOI or ID number:	10.1016/j.lansea.2024.100507
URI:	https://researchonline.ljmu.ac.uk/id/eprint/24995

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