Identifying risk patterns in older adults with atrial fibrillation by hierarchical cluster analysis: A retrospective approach based on the risk probability for clinical events

Suzuki, Shinya; Yamashita, Takeshi; Otsuka, Takayuki; Arita, Takuto; Yagi, Nobuyuki; Kishi, Mikio; Semba, Hiroaki; Kuwabara, Hiroto; Matsuno, Seiki; Kato, Yuko; Uejima, Tokuhisa; Oikawa, Yuji; Matsuhama, Minoru; Iida, Mitsuru; Inoue, Tatsuya; Yajima, Junji

doi:10.1016/j.ijcha.2021.100883

Cited by 9 publications

(8 citation statements)

References 35 publications

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“…Our analysis yielded three patient clusters, each with distinct characteristics and cost trajectories: CV with rather high costs, SM with similarly high costs and IS with substantially lower costs. Some attempts to cluster the heterogeneity of patients with AF were reported previously, but not linked with cost trajectories 12 26–28. To facilitate an understanding of observed trajectories, we based our analysis on patient baseline characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…The prospective cohort study patients we report on differ from the patient populations underlying recent AF cost studies in four ways, with implications for the interpretation of the results. First, most studies to date relied on administrative databases only21 25 29; second, they were often retrospective19 21 25 27; and third, they had short follow-up times between 0.5 and 3 years 19 24. By combining clinical and health insurance claims data prospectively, we add information on the longer-term healthcare costs of patients with AF.…”

Section: Discussionmentioning

confidence: 99%

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Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort

Aebersold

Serra-Burriel

Foster-Wittassek

et al. 2022

Heart

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ObjectiveEvidence on long-term costs of atrial fibrillation (AF) and associated factors is scarce. As part of the Swiss-AF prospective cohort study, we aimed to characterise AF costs and their development over time, and to assess specific patient clusters and their cost trajectories.MethodsSwiss-AF enrolled 2415 patients with variable duration of AF between 2014 and 2017. Patient clusters were identified using hierarchical cluster analysis of baseline characteristics. Ongoing yearly follow-ups include health insurance clinical and claims data. An algorithm was developed to adjudicate costs to AF and related complications.ResultsA subpopulation of 1024 Swiss-AF patients with available claims data was followed up for a median (IQR) of 3.24 (1.09) years. Average yearly AF-adjudicated costs amounted to SFr5679 (€5163), remaining stable across the observation period. AF-adjudicated costs consisted mainly of inpatient and outpatient AF treatment costs (SFr4078; €3707), followed by costs of bleeding (SFr696; €633) and heart failure (SFr494; €449). Hierarchical analysis identified three patient clusters: cardiovascular (CV; N=253 with claims), isolated-symptomatic (IS; N=586) and severely morbid without cardiovascular disease (SM; N=185). The CV cluster and SM cluster depicted similarly high costs across all cost outcomes; IS patients accrued the lowest costs.ConclusionOur results highlight three well-defined patient clusters with specific costs that could be used for stratification in both clinical and economic studies. Patient characteristics associated with adjudicated costs as well as cost trajectories may enable an early understanding of the magnitude of upcoming AF-related healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort

Aebersold

Serra-Burriel

Foster-Wittassek

et al. 2022

Heart

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“…Some attempts to cluster the heterogeneity of AF patients were reported previously, but not linked with cost trajectories. 12,[26][27][28] To facilitate an understanding of expected patient trajectories, we based our analysis on baseline characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…12,26 The prospective cohort study patients we report on differ from the patient populations underlying recent AF costs studies in four ways, which has implication for the interpretation of the results. Firstly, most studies to-date relied on administrative databases 21,25,30 ; secondly, they were often retrospective 19,21,25,27 ; and thirdly, had short follow-up times between 0.5 to 3 years 19,24,29 . In combining clinical and health insurance claims data prospectively, the present analysis adds detailed insight into the longer-term healthcare costs of AF patients.…”

Section: Discussionmentioning

confidence: 99%

Patient Clusters and Cost Trajectories in Atrial Fibrillation: Evidence from the Swiss Atrial Fibrillation Cohort

Aebersold

Serra-Burriel

Foster-Witassek

et al. 2022

Preprint

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AimsEvidence on long-term costs of atrial fibrillation (AF) and associated factors is scarce. As part of the Swiss-AF prospective cohort study we aimed to characterise AF costs and their development over time, and to assess specific patient clusters and their cost trajectories.MethodsSwiss-AF enrolled 2,415 patients with variable duration of AF between 2014 and 2017. Patient clusters were identified using hierarchical cluster analysis of baseline characteristics. Ongoing yearly follow-ups include health insurance clinical and claims data. An algorithm was developed to adjudicate costs to AF and related complications.ResultsHierarchical analysis identified three patient clusters. “Cardiovascular-dominated” (CV-dominated) patients had the highest proportions of prior myocardial infarction and presence of diabetes. “Heart failure-dominated” (HF-dominated) patients had the highest occurrence of heart failure and permanent AF. “Isolated symptomatic” (IS) patients were younger and had the highest occurrence of paroxysmal AF. A subpopulation of 1,024 Swiss-AF patients with available claims data was followed up for a median [interquartile range] of 3.24 [1.09] years. Average yearly AF-adjudicated costs amounted to CHF 5,679, remaining stable across the observation period. CV-dominated (N = 253 with claims data) and HF-dominated patients (N = 185) depicted similarly high costs across all cost outcomes, the IS (N = 586) patients accrued the lowest costs.ConclusionOur results highlight three well-differentiated patient clusters with specific costs that could be used for stratification in both clinical and economic studies. Patient characteristics associated with adjudicated costs as well as cost trajectories may enable an early understanding of the magnitude of upcoming AF-related healthcare costs.What is already known on this topicAtrial fibrillation (AF) is a complex disease and constitutes a major economic and societal challenge due to its high prevalence worldwide.What this study addsThis study, based on a large prospective cohort study, provides evidence on real-world AF costs and their development over time. Data-derived patient clusters are linked to costs and their respective cost trajectories are assessed.How this study might affect research, practice or policyThe identified patient clusters and their characteristics may help clinicians and payers to gain an early insight and understanding of the magnitude of the expected AF-related healthcare costs.

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“…Several cluster analyses have reportedly identified up to seven clinical phenotypes in patients with AF, with many of these analyses indicating that rates of mortality or major adverse cardiovascular or neurological events (MACNE) could be stratified by cluster [11][12][13][14][15][16]. For example, in an analysis of patients enrolled in the ORBIT-AF Registry, the incidence rates of MACNE were 2.58%, 3.97%, 5.10%, and 6.12% per year for clusters defined by low comorbidity rates, younger age or comorbid behavioral disorders, device implantation, or atherosclerotic comorbidities, respectively [11].…”

Section: Introductionmentioning

confidence: 99%

Clinical phenotypes of older adults with non-valvular atrial fibrillation not treated with oral anticoagulants by hierarchical cluster analysis in the ANAFIE Registry

et al. 2023

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Background Although anticoagulants are indicated for many elderly patients with non-valvular atrial fibrillation (NVAF), some patients do not receive anticoagulant therapy, whose characteristics and outcomes are diverse. Methods and results In this sub-analysis of the All Nippon AF In the Elderly (ANAFIE) Registry, the phenotypes of patients who were not receiving anticoagulants at baseline were evaluated by cluster analysis using Ward’s linkage hierarchical algorithm. Of 32,275 enrolled patients, 2445 (7.6%) were not receiving anticoagulants. Two clusters were identified: (1) elderly paroxysmal AF (PAF) patients with a high proportion of catheter ablation history (57%) and (2) very elderly patients with a high prevalence of previous major bleeding (43%). Respective mean ages were 80.9 and 84.2 years, mean CHA2DS2-VASc scores were 3.8 and 4.9, PAF prevalences were 100.0% and 31.4%, proportions of patients with catheter ablation history were 21.0% and 7.9%, and proportions of patients with a history of major bleeding were 4.0% and 10.8%. Annual incidence rates were 2.72% and 8.81% for all-cause death, 1.66% and 5.85% for major adverse cardiovascular or neurological events, 1.08% and 3.30% for stroke or systemic embolism, and 0.69% and 1.19% for major bleeding, respectively. Conclusions In this cohort of elderly NVAF patients from the ANAFIE Registry who were not receiving anticoagulants, over half had PAF with a high proportion of catheter ablation history and a low incidence of adverse outcomes; for them, non-prescription of anticoagulants may be partially understandable, but they should be carefully monitored regarding AF burden or atrial cardiomyopathy and be adequately anticoagulated when adverse findings are detected. The remaining were very elderly patients with a high prevalence of previous major bleeding and a high incidence of adverse outcomes; for them, non-prescription of anticoagulants is inappropriate because of the high thromboembolic risk. Trial registration Registration: http://www.umin.ac.jp/; Unique identifier: UMIN000024006.

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Identifying risk patterns in older adults with atrial fibrillation by hierarchical cluster analysis: A retrospective approach based on the risk probability for clinical events

Cited by 9 publications

References 35 publications

Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort

Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort

Patient Clusters and Cost Trajectories in Atrial Fibrillation: Evidence from the Swiss Atrial Fibrillation Cohort

Clinical phenotypes of older adults with non-valvular atrial fibrillation not treated with oral anticoagulants by hierarchical cluster analysis in the ANAFIE Registry

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