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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

Insights

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.

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.

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