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Using Latent Class Analysis to Identify Different Clinical Profiles Among Patients With Advanced Heart Failure

  • Author Footnotes
    # MB and KMcK contributed equally to this work and should be considered co-first authors.
    Moritz Blum
    Footnotes
    # MB and KMcK contributed equally to this work and should be considered co-first authors.
    Affiliations
    Brookdale Department of Geriatrics and Palliative Medicine (M.B., K.M., L.P.G., N.E.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Department of Internal Medicine/Cardiology (M.B.), Charité–Universitätsmedizin Berlin, Berlin, Germany
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  • Author Footnotes
    # MB and KMcK contributed equally to this work and should be considered co-first authors.
    Karen McKendrick
    Correspondence
    Address correspondence to: Karen McKendrick, MPH, Department of Geriatrics and Palliative Medicine, Mount Sinai Medical Center, One Gustave Levy Place, Box 1070, New York, NY 10029 USA.
    Footnotes
    # MB and KMcK contributed equally to this work and should be considered co-first authors.
    Affiliations
    Brookdale Department of Geriatrics and Palliative Medicine (M.B., K.M., L.P.G., N.E.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
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  • Laura P. Gelfman
    Affiliations
    Brookdale Department of Geriatrics and Palliative Medicine (M.B., K.M., L.P.G., N.E.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA

    James J. Peters Veterans Affairs Medical Center (L.P.G.), Geriatric Research Education and Clinical Center (GRECC), Bronx, New York, USA
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  • Sean P. Pinney
    Affiliations
    University of Chicago Medicine (S.P.P.), Chicago, Illinois, USA
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  • Nathan E. Goldstein
    Affiliations
    Brookdale Department of Geriatrics and Palliative Medicine (M.B., K.M., L.P.G., N.E.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
    Search for articles by this author
  • Author Footnotes
    # MB and KMcK contributed equally to this work and should be considered co-first authors.

      Abstract

      Context

      Although palliative care is guideline-indicated for patients with advanced heart failure (HF), the scarcity of a specialty-trained palliative care workforce demands better identification of patients who are most burdened by the disease

      Objectives

      We sought to identify latent subgroups with variations regarding symptom burden, functional status, and multimorbidity in an advanced HF population.

      Methods

      We performed a latent class analysis (LCA) of baseline data from a trial enrolling advanced HF patients. As LCA input variables, we chose indicators of HF severity, physical and psychological symptom burden, functional status, and the number of comorbidities.

      Results

      Among 563 patients, two subgroups emerged from LCA, Class A (352 [62.5%]) and Class B (211 [37.5%]). Patients in Class A were less often classified as NYHA class III or IV (88.0% vs. 97.5%, P < 0.001), as compared to Class B patients. Class A patients had fewer symptoms, fewer comorbidities, only 25.9% had impairments in activities of daily living (ADL), and virtually none suffered from clinically significant anxiety (0.4%) or depression (0.9%). In Class B, every patient reported more than three symptoms, almost all patients (92.6%) had some impairment in ADL, and nearly a third had anxiety (30.2%) or depression (28.3%). All-cause mortality after 12 months was higher in Class B, as compared to Class A (18.5% vs. 12.5%, P = 0.047).

      Conclusion

      Among advanced HF patients, we identified a distinct subgroup characterized by a conjunction of high symptom burden, anxiety, depression, multimorbidity, and functional status impairment, which might profit particularly from palliative care interventions.

      Graphical Abstract

      Key Words

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