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Thromb Haemost
DOI: 10.1055/a-2559-9994
Stroke, Systemic or Venous Thromboembolism

Latent Class Analysis for the Identification of Phenotypes Associated with Increased Risk in Atrial Fibrillation Patients: The COOL-AF Registry

Rungroj Krittayaphong
1   Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Sukrit Treewaree 
1   Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Ahthit Yindeengam
2   Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Chulalak Komoltri
3   Department of Research Promotion, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Gregory Y. H. Lip 
4   Liverpool Centre for Cardiovascular Science, at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
5   Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
› Author Affiliations Funding This study was funded by grants from the Health Systems Research Institute (HSRI) (grant no. 59-053), and the Heart Association of Thailand under the Royal Patronage of H.M. the King. None of the funding sources influenced any aspect of this study or the decision of the authors to submit this manuscript for publication.
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Abstract

Background

Patients with atrial fibrillation (AF) often have clinical complexity phenotypes. Latent class analysis (LCA) is based on the concept of modeling of both observed and unobserved (latent) variables. We hypothesized that LCA can help in identification of AF patient groups with different risk profiles and identify patients who benefit most from the Atrial fibrillation Better Care (ABC) pathway.

Methods

We studied non-valvular AF patients in the prospective multicenter COOL-AF registry. The outcomes were all-cause death, ischemic stroke/systemic embolism (SSE), major bleeding, and heart failure. Components of CHA2DS2-VASc score, HAS-BLED score, and ABC pathway were recorded.

Results

A total of 3,405 patients were studied. We identified 3 LCA groups from 42 variables: LCA class 1 (n = 1,238), LCA class 2 (n = 1,790), and LCA class 3 (n = 377). Overall, the incidence rates of composite outcomes, death, SSE, major bleeding, and heart failure were 8.69, 4.21, 1.51, 2.27, and 2.84 per 100 person-years, respectively. When compared to LCA class 1, hazard ratios (HR) of composite outcome of LCA classes 3 and 2 were 3.86 (3.06–4.86) and 2.31 (1.91–2.79), respectively. ABC pathway compliance was associated with better outcomes in LCA classes 2 and 3 with the HR of 0.63 (0.51–0.76) and 0.57 (0.39–0.84), but not in LCA class 1.

Conclusion

LCA can identify patients who are at risk of developing adverse clinical outcomes. The implementation of holistic management based on the ABC pathway was associated with a reduction in the composite outcomes as well as the individual outcomes.

Keywords

atrial fibrillation - latent class analysis - ABC pathway - oral anticoagulants

The review process for this paper was fully handled by Christian Weber, Editor in Chief.


Data Availability Statement

The dataset that was used to support the results and conclusion of this study are included within the manuscript. Additional data are available upon contacting the corresponding author with reasonable request.


Author's Contribution

All authors made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work.


Supplementary Material



Publication History

Received: 11 December 2024

Accepted: 17 March 2025

Accepted Manuscript online:
18 March 2025

Article published online:
08 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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