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A population-based study exploring phenotypic clusters and clinical outcomes in stroke using unsupervised machine

Ralph K Akyea1, George Ntaios2, Evangelos Kontopantelis3,4

  • 1PRISM Research Group, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom.

PLOS Digital Health
|September 13, 2023
PubMed
Summary
This summary is machine-generated.

This study identified four distinct patient phenotypes after stroke, revealing varying risks for recurrent stroke and cardiovascular death. These findings suggest personalized care strategies can improve outcomes for stroke survivors.

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Area of Science:

  • Cardiology
  • Neurology
  • Data Science

Background:

  • Stroke patients exhibit diverse clinical, demographic, and biochemical profiles.
  • This heterogeneity influences cardiovascular disease (CVD) morbidity and mortality.
  • Current care stratification may not fully address individual patient risks post-stroke.

Purpose of the Study:

  • To stratify incident stroke patients into distinct phenotypic clusters using a novel approach.
  • To evaluate the differential risks of recurrent stroke and other major cardiovascular outcomes among these phenotypes.
  • To explore opportunities for improved patient care stratification.

Main Methods:

  • Utilized linked UK clinical data (primary care, hospitalizations, death records) for 48,114 adult patients with incident stroke.
  • Applied a data-driven clustering analysis (kamila algorithm) to identify patient phenotypes.
  • Employed Cox proportional hazards regression to estimate risks for adverse outcomes, including coronary heart disease, recurrent stroke, heart failure, and mortality.

Main Results:

  • Identified four distinct stroke patient phenotypes.
  • Compared to cluster 1, clusters 2, 3, and 4 showed significantly higher risks for composite recurrent stroke and CVD-related mortality (HRs 1.07-1.44).
  • Similar risk trends were observed for recurrent stroke and all-cause mortality, but not consistently for all individual cardiovascular outcomes.

Conclusions:

  • Demonstrated successful stratification of heterogeneous stroke patients into four homogenous phenotypes.
  • These phenotypes exhibit differential risks for recurrent stroke and major cardiovascular outcomes.
  • The findings support revisiting stroke care stratification to enhance patient outcomes.