Lacki Alexander, Martinez-Millana Antonio
Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Camino de Vera S/N, 46022 Valencia, Spain.
Bioengineering (Basel). 2024 Feb 20;11(3):199. doi: 10.3390/bioengineering11030199.
Critical care physicians are commonly faced with patients exhibiting atrial fibrillation (AF), a cardiac arrhythmia with multifaceted origins. Recent investigations shed light on the heterogeneity among AF patients by uncovering unique AF phenotypes, characterized by differing treatment strategies and clinical outcomes. In this retrospective study encompassing 9401 AF patients in an intensive care cohort, we sought to identify differences in average treatment effects (ATEs) across different patient groups. We extract data from the MIMIC-III database, use hierarchical agglomerative clustering to identify patients' phenotypes, and assign them to treatment groups based on their initial drug administration during AF episodes. The treatment options examined included beta blockers (BBs), potassium channel blockers (PCBs), calcium channel blockers (CCBs), and magnesium sulfate (MgS). Utilizing multiple imputation and inverse probability of treatment weighting, we estimate ATEs related to rhythm control, rate control, and mortality, approximated as hourly and daily rates (%/h, %/d). Our analysis unveiled four distinctive AF phenotypes: (1) postoperative hypertensive, (2) non-cardiovascular mutlimorbid, (3) cardiovascular multimorbid, and (4) valvulopathy atrial dilation. PCBs showed the highest cardioversion rates across phenotypes, ranging from 11.6%/h (9.35-13.3) to 7.69%/h (5.80-9.22). While CCBs demonstrated the highest effectiveness in controlling ventricular rates within the overall patient cohort, PCBs and MgS outperformed them in specific phenotypes. PCBs exhibited the most favorable mortality outcomes overall, except for the non-cardiovascular multimorbid cluster, where BBs displayed a lower mortality rate of 1.33%/d [1.04-1.93] compared to PCBs' 1.68%/d [1.10-2.24]. The results of this study underscore the significant diversity in ATEs among individuals with AF and suggest that phenotype-based classification could be a valuable tool for physicians, providing personalized insights to inform clinical decision making.
重症监护医生经常会遇到患有心房颤动（AF）的患者，这是一种起源多方面的心律失常。最近的研究通过揭示独特的房颤表型，即具有不同治疗策略和临床结果的表型，揭示了房颤患者之间的异质性。在这项回顾性研究中，我们纳入了9401名重症监护队列中的房颤患者，试图确定不同患者组之间平均治疗效果（ATEs）的差异。我们从MIMIC-III数据库中提取数据，使用层次凝聚聚类来识别患者的表型，并根据房颤发作期间的初始药物给药情况将他们分配到治疗组。所研究的治疗选择包括β受体阻滞剂（BBs）、钾通道阻滞剂（PCBs）、钙通道阻滞剂（CCBs）和硫酸镁（MgS）。利用多重填补和治疗权重的逆概率，我们估计了与节律控制、心率控制和死亡率相关的ATEs，以每小时和每天的比率（%/h，%/d）近似表示。我们的分析揭示了四种不同的房颤表型：（1）术后高血压型，（2）非心血管多病症型，（3）心血管多病症型，以及（4）瓣膜病心房扩张型。PCBs在各表型中的复律率最高，范围从11.6%/h（9.35 - 13.3）到7.69%/h（5.80 - 9.22）。虽然CCBs在整个患者队列中显示出控制心室率的最高有效性，但PCBs和MgS在特定表型中表现优于CCBs。总体而言，PCBs表现出最有利的死亡率结果，但非心血管多病症组除外，在该组中，BBs的死亡率为1.33%/d[1.04 - 1.93]，低于PCBs的1.68%/d[1.10 - 2.24]。这项研究的结果强调了房颤患者个体之间ATEs的显著差异，并表明基于表型的分类可能是医生的一个有价值的工具，为临床决策提供个性化的见解。
