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Clustering based on...
Clustering based on comorbidities in patients with chronic heart failure: an illustration of clinical diversity
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Uszko-Lencer, Nhmk (author)
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Janssen, D. J. A. (author)
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Gaffron, S. (author)
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- Vanfleteren, Lowie E G W (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
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Janssen, E. (author)
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Werter, C. (author)
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Franssen, F. M. E. (author)
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Wouters, E. F. M. (author)
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Rechberger, S. (author)
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La Rocca, H. P. B. (author)
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Spruit, M. A. (author)
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(creator_code:org_t)
- 2021-11-18
- 2022
- English.
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In: ESC Heart Failure. - : Wiley. - 2055-5822. ; 9:1, s. 614-626
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Abstract
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- Aims It is increasingly recognized that the presence of comorbidities substantially contributes to the disease burden in patients with heart failure (HF). Several reports have suggested that clustering of comorbidities can lead to improved characterization of the disease phenotypes, which may influence management of the individual patient. Therefore, we aimed to cluster patients with HF based on medical comorbidities and their treatment and, subsequently, compare the clinical characteristics between these clusters. Methods and results A total of 603 patients with HF entering an outpatient HF rehabilitation programme were included [median age 65 years (interquartile range 56-71), 57% ischaemic origin of cardiomyopathy, and left ventricular ejection fraction 35% (26-45)]. Exercise performance, daily life activities, disease-specific health status, coping styles, and personality traits were assessed. In addition, the presence of 12 clinically relevant comorbidities was recorded, based on targeted diagnostics combined with applicable pharmacotherapies. Self-organizing maps (SOMs; ) were used to visualize clusters, generated by using a hybrid algorithm that applies the classical hierarchical cluster method of Ward on top of the SOM topology. Five clusters were identified: (1) a least comorbidities cluster; (2) a cachectic/implosive cluster; (3) a metabolic diabetes cluster; (4) a metabolic renal cluster; and (5) a psychologic cluster. Exercise performance, daily life activities, disease-specific health status, coping styles, personality traits, and number of comorbidities were significantly different between these clusters. Conclusions Distinct combinations of comorbidities could be identified in patients with HF. Therapy may be tailored based on these clusters as next step towards precision medicine. The effect of such an approach needs to be prospectively tested.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Heart failure
- Clustering
- Comorbidities
- pulmonary rehabilitation
- coping styles
- reliability
- validity
- copd
- frailty
- life
- care
- Cardiovascular System & Cardiology
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Uszko-Lencer, Nh ...
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Janssen, D. J. A ...
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Gaffron, S.
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Vanfleteren, Low ...
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Janssen, E.
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Werter, C.
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show more...
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Franssen, F. M. ...
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Wouters, E. F. M ...
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Rechberger, S.
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La Rocca, H. P. ...
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Spruit, M. A.
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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ESC Heart Failur ...
- By the university
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University of Gothenburg