Clinical Phenotyping and Treatment Response in Patients With Chronic Heart Failure

There are little data on clinically meaningful heart failure (HF) phenogroups, which are associated with treatment response across the wide spectrum of left ventricular (LV) ejection fraction.

The authors aimed to identify the phenotypes of patients with HF with different prognoses and responses to medical therapies.

We examined consecutive 2,301 chronic HF patients from the ELMSTAT-HF (EpidemioLogical Multicenter Study for Tailored Treatment in Heart Failure) registry, a prospective multicenter cohort in which 2,317 patients were enrolled between January 2020 and September 2024. Latent class analysis was performed using 99 clinical features. The primary outcome was a composite of all-cause death and hospitalization for worsening HF.

The analysis subclassified the patients into 8 phenogroups: group 1, characterized by younger age with obesity; 2, less structural abnormality and comorbidity; 3, younger age with LV dilation; 4, LV hypertrophy; 5, older age with small LV and diastolic dysfunction; 6, ischemic cardiomyopathy; 7, advanced LV remodeling and ventricular arrhythmias; and 8, atrial myopathy. During a median follow-up of 597 (IQR: 302-932) days, the incidence of the primary outcome significantly differed between the phenogroups (P < 0.001). In phenogroup 5, patients taking beta-blockers or sodium-glucose cotransporter 2 inhibitors had a significantly higher rate of hospitalization for worsening HF (HR: 2.20; 95% CI: 1.04-4.68; HR: 4.27; 95% CI: 2.02-9.05, respectively).

We identified 8 phenogroups with distinct clinical outcomes in patients with HF. This phenotyping provides appropriate risk stratification and may aid clinical decision-making in patients with HF.