{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:37:51Z","timestamp":1785818271408,"version":"3.56.0"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"01","funder":[{"DOI":"10.13039\/501100010724","name":"Health Systems Research Institute","doi-asserted-by":"crossref","award":["59-053"],"award-info":[{"award-number":["59-053"]}],"id":[{"id":"10.13039\/501100010724","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100032332","name":"Heart Association of Thailand","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100032332","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Patients with atrial fibrillation (AF) often have clinical complexity phenotypes. Latent class analysis (LCA) is based on the concept of modeling of both observed and unobserved (latent) variables. We hypothesized that LCA can help in identification of AF patient groups with different risk profiles and identify patients who benefit most from the Atrial fibrillation Better Care (ABC) pathway.<\/jats:p>\n                  <jats:p>We studied non-valvular AF patients in the prospective multicenter COOL-AF registry. The outcomes were all-cause death, ischemic stroke\/systemic embolism (SSE), major bleeding, and heart failure. Components of CHA2DS2-VASc score, HAS-BLED score, and ABC pathway were recorded.<\/jats:p>\n                  <jats:p>A total of 3,405 patients were studied. We identified 3 LCA groups from 42 variables: LCA class 1 (n\u2009=\u20091,238), LCA class 2 (n\u2009=\u20091,790), and LCA class 3 (n\u2009=\u2009377). Overall, the incidence rates of composite outcomes, death, SSE, major bleeding, and heart failure were 8.69, 4.21, 1.51, 2.27, and 2.84 per 100 person-years, respectively. When compared to LCA class 1, hazard ratios (HR) of composite outcome of LCA classes 3 and 2 were 3.86 (3.06\u20134.86) and 2.31 (1.91\u20132.79), respectively. ABC pathway compliance was associated with better outcomes in LCA classes 2 and 3 with the HR of 0.63 (0.51\u20130.76) and 0.57 (0.39\u20130.84), but not in LCA class 1.<\/jats:p>\n                  <jats:p>LCA can identify patients who are at risk of developing adverse clinical outcomes. The implementation of holistic management based on the ABC pathway was associated with a reduction in the composite outcomes as well as the individual outcomes.<\/jats:p>","DOI":"10.1055\/a-2559-9994","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T20:27:31Z","timestamp":1742329651000},"page":"095-106","source":"Crossref","is-referenced-by-count":12,"title":["Latent Class Analysis for the Identification of Phenotypes Associated with Increased Risk in Atrial Fibrillation Patients: The COOL-AF Registry"],"prefix":"10.1055","volume":"126","author":[{"given":"Rungroj","family":"Krittayaphong","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4248-2066","authenticated-orcid":false,"given":"Sukrit","family":"Treewaree","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahthit","family":"Yindeengam","sequence":"additional","affiliation":[{"name":"Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chulalak","family":"Komoltri","sequence":"additional","affiliation":[{"name":"Department of Research Promotion, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science, at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom"},{"name":"Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,4,8]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.26599\/1671-5411.2023.03.008","article-title":"Three-year outcomes of patients with non-valvular atrial fibrillation: the COOL-AF registry","volume":"20","author":"R Krittayaphong","year":"2023","journal-title":"J Geriatr Cardiol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"100786","DOI":"10.1016\/j.lanepe.2023.100786","article-title":"Atrial fibrillation: epidemiology, screening and digital health","volume":"37","author":"D Linz","year":"2024","journal-title":"Lancet Reg Health Eur"},{"issue":"12","key":"ref3","doi-asserted-by":"crossref","first-page":"2030","DOI":"10.1055\/s-0042-1756355","article-title":"Clinical complexity domains, anticoagulation, and outcomes in patients with atrial fibrillation: a report from the GLORIA-AF Registry Phase II and III","volume":"122","author":"G F Romiti","year":"2022","journal-title":"Thromb Haemost"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1055\/s-0043-1769735","article-title":"The impact of polypharmacy on the effectiveness and safety of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation","volume":"124","author":"M Grymonprez","year":"2024","journal-title":"Thromb Haemost"},{"issue":"12","key":"ref5","doi-asserted-by":"crossref","first-page":"3571","DOI":"10.1161\/STROKEAHA.115.010954","article-title":"Nontraditional risk factors for ischemic stroke: an update","volume":"46","author":"O Y Bang","year":"2015","journal-title":"Stroke"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"102181","DOI":"10.1016\/j.cpcardiol.2023.102181","article-title":"Atrial fibrillation and stroke: state-of-the-art and future directions","volume":"49","author":"S Elsheikh","year":"2024","journal-title":"Curr Probl Cardiol"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5114\/aoms.2019.84212","article-title":"Atrial fibrillation risk factors in patients with ischemic stroke","volume":"17","author":"P Wa\u0144kowicz","year":"2019","journal-title":"Arch Med Sci"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/qjmed\/hcad219","article-title":"Clinical phenotype classification to predict risk and optimize the management of patients with atrial fibrillation using the Atrial Fibrillation Better Care (ABC) pathway: a report from the COOL-AF registry","volume":"117","author":"R Krittayaphong","year":"2024","journal-title":"QJM"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1055\/s-0041-1739411","article-title":"2021 focused update consensus guidelines of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation: executive summary","volume":"122","author":"T F Chao","year":"2022","journal-title":"Thromb Haemost"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"101757","DOI":"10.1016\/j.eclinm.2022.101757","article-title":"Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: a post-hoc analysis from the prospective GLORIA-AF Registry","volume":"55","author":"G F Romiti","year":"2022","journal-title":"EClinicalMedicine"},{"issue":"11","key":"ref11","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1055\/s-0043-1769612","article-title":"Mobile health-technology-integrated care for atrial fibrillation: a win ratio analysis from the mAFA-II randomized clinical trial","volume":"123","author":"G F Romiti","year":"2023","journal-title":"Thromb Haemost"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.1097\/CCM.0000000000004710","article-title":"Practitioner's guide to latent class analysis: methodological considerations and common pitfalls","volume":"49","author":"P Sinha","year":"2021","journal-title":"Crit Care Med"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12916-025-03858-w","article-title":"Patterns of pharmacological treatment in patients with atrial fibrillation: an analysis from the prospective GLORIA-AF Registry Phase III","volume":"23","author":"B Corica","year":"2025","journal-title":"BMC Med"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1111\/pace.13356","article-title":"Atrial fibrillation symptom profiles associated with healthcare utilization: a latent class regression analysis","volume":"41","author":"M M Streur","year":"2018","journal-title":"Pacing Clin Electrophysiol"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s12916-024-03373-4","article-title":"Patterns of comorbidities in patients with atrial fibrillation and impact on management and long-term prognosis: an analysis from the Prospective Global GLORIA-AF Registry","volume":"22","author":"G F Romiti","year":"2024","journal-title":"BMC Med"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1186\/s12872-018-0911-4","article-title":"Risk profiles and pattern of antithrombotic use in patients with non-valvular atrial fibrillation in Thailand: a multicenter study","volume":"18","author":"R Krittayaphong","year":"2018","journal-title":"BMC Cardiovasc Disord"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients","volume":"3","author":"S Schulman","year":"2005","journal-title":"J Thromb Haemost"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jacc.2014.12.018","article-title":"2014 ACC\/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards)","volume":"66","author":"K A Hicks","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"101747","DOI":"10.1016\/j.mex.2022.101747","article-title":"Latent class cluster analysis: selecting the number of clusters","volume":"9","author":"O Lezhnina","year":"2022","journal-title":"MethodsX"},{"issue":"11","key":"ref20","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1038\/nrcardio.2017.153","article-title":"The ABC pathway: an integrated approach to improve AF management","volume":"14","author":"G YH Lip","year":"2017","journal-title":"Nat Rev Cardiol"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1055\/s-0038-1651587","article-title":"A method to determine the optimal intensity of oral anticoagulant therapy","volume":"69","author":"F R Rosendaal","year":"1993","journal-title":"Thromb Haemost"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1378\/chest.09-1584","article-title":"Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation","volume":"137","author":"G Y Lip","year":"2010","journal-title":"Chest"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1378\/chest.10-0134","article-title":"A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey","volume":"138","author":"R Pisters","year":"2010","journal-title":"Chest"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"842306","DOI":"10.3389\/frai.2022.842306","article-title":"Phenotype clustering in health care: a narrative review for clinicians","volume":"5","author":"T J Loftus","year":"2022","journal-title":"Front Artif Intell"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1186\/s12859-022-04769-w","article-title":"Euclidean distance-optimized data transformation for cluster analysis in biomedical data (EDOtrans)","volume":"23","author":"A Ultsch","year":"2022","journal-title":"BMC Bioinformatics"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1080\/10543406.2014.920855","article-title":"On comparison of clustering methods for pharmacoepidemiological data","volume":"25","author":"F Feuillet","year":"2015","journal-title":"J Biopharm Stat"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1161\/CIRCULATIONAHA.121.057480","article-title":"ECG-based deep learning and clinical risk factors to predict atrial fibrillation","volume":"145","author":"S Khurshid","year":"2022","journal-title":"Circulation"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"13","DOI":"10.3390\/technologies12020013","article-title":"Machine learning approaches to predict major adverse cardiovascular events in atrial fibrillation","volume":"12","author":"P Molt\u00f3-Balado","year":"2024","journal-title":"Technologies (Basel)"},{"issue":"09","key":"ref29","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1093\/europace\/euab079","article-title":"Characteristics and clinical outcomes in atrial fibrillation patients classified using cluster analysis: the Fushimi AF Registry","volume":"23","author":"H Ogawa","year":"2021","journal-title":"Europace"},{"issue":"07","key":"ref30","doi-asserted-by":"crossref","first-page":"843","DOI":"10.3390\/biomedicines9070843","article-title":"Clinical phenotype classification of atrial fibrillation patients using cluster analysis and associations with trial-adjudicated outcomes","volume":"9","author":"M Vitolo","year":"2021","journal-title":"Biomedicines"},{"issue":"03","key":"ref31","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1055\/a-1515-9630","article-title":"Adherence to the \u201cAtrial Fibrillation Better Care\u201d pathway in patients with atrial fibrillation: impact on clinical outcomes\u2014a systematic review and meta-analysis of 285,000 patients","volume":"122","author":"G F Romiti","year":"2022","journal-title":"Thromb Haemost"},{"issue":"03","key":"ref32","doi-asserted-by":"crossref","first-page":"e028463","DOI":"10.1161\/JAHA.122.028463","article-title":"Impact of achieving blood pressure targets and high time in therapeutic range on clinical outcomes in patients with atrial fibrillation adherent to the atrial fibrillation better care pathway: a report from the COOL-AF Registry","volume":"12","author":"R Krittayaphong","year":"2023","journal-title":"J Am Heart Assoc"},{"issue":"10","key":"ref33","doi-asserted-by":"crossref","first-page":"e0164076","DOI":"10.1371\/journal.pone.0164076","article-title":"Quality of vitamin K antagonist control and 1-year outcomes in patients with atrial fibrillation: a global perspective from the GARFIELD-AF Registry","volume":"11","author":"S Haas","year":"2016","journal-title":"PLoS One"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s11239-024-03007-9","article-title":"Clinical outcomes of patients with atrial fibrillation in relation to multimorbidity status changes over time and the impact of ABC pathway compliance: a nationwide cohort study","volume":"58","author":"R Krittayaphong","year":"2025","journal-title":"J Thromb Thrombolysis"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1177\/0095798420930932","article-title":"Latent class analysis: a guide to best practice","volume":"46","author":"B E Weller","year":"2020","journal-title":"J Black Psychol"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"100549","DOI":"10.1016\/j.lansea.2025.100549","article-title":"The burden of atrial fibrillation and unmet needs of its management in Southeast Asia and South Asia","volume":"34","author":"R Krittayaphong","year":"2025","journal-title":"Lancet Reg Health Southeast Asia"}],"container-title":["Thrombosis and Haemostasis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2559-9994.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T23:39:01Z","timestamp":1767397141000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2559-9994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,18]]},"references-count":36,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,1,2]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2559-9994","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0340-6245","2567-689X"],"issn-type":[{"value":"0340-6245","type":"print"},{"value":"2567-689X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,3,18]]},"published":{"date-parts":[[2025,3,18]]}}}