Observational studyJournal of cardiovascular electrophysiology2025
Clinical Phenotypes in Relation to Outcomes in Heart Failure Patients With Cardiac Resynchronization Therapy and Defibrillators (CRT-D): An Unsupervised Cluster Analysis.
Observational study in Journal of cardiovascular electrophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPatients with heart failure undergoing cardiac resynchronization therapy (CRT) are a heterogenous and complex population.
objectiveTo identify different clusters of patients with CRT-D and to evaluate the associations with clinical outcomes, using cluster analysis (CAs).
methodsThree agglomerative hierarchical CAs were performed in CRT-D patients seen between 2010 and 2019 in French hospitals. Associations between clusters and death at 1 year and death during the whole follow-up (FU) were evaluated.
resultsThe study included 23 029 CRT-D patients, who were analyzed in three ways, as follows: the first group was a 50% random sample of all patients (n = 11 514), the second group included patients who were dead at 1 year (n = 1604) and the third group included those alive at 3 years FU (n = 14 228). A CA was performed on each group of patients. Four clusters were identified: Cluster 1 corresponded to the low-risk phenotype; Cluster 2 to patients with coronary artery disease (CAD) with few cardiovascular (CV) risk factors and comorbidities; Cluster 3 included patients with CV risk factors and comorbidities, but low CAD; Cluster 4 corresponded to clinically complex phenotype (CAD with CV risk factors and comorbidities). Compared with Cluster 1, Clusters 2, 3, and 4 were independently associated with an increased risk of all-cause death at 1-year FU and during the whole FU (Cluster 2: hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.08-1.36; Cluster 3: HR 1.15, 95% CI 1.04-1.26; and Cluster 4: HR 1.79, 95% CI 1.65-1.96).
conclusionCAs identified four statistically driven groups of CRT recipients, with specific clinical phenotypes and associated with different risks for all-cause death.
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