{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T00:09:14Z","timestamp":1793578154939,"version":"4.5.0"},"reference-count":38,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T00:00:00Z","timestamp":1691107200000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"crossref","award":["R00NR019124"],"award-info":[{"award-number":["R00NR019124"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"crossref","award":["T32NR007969"],"award-info":[{"award-number":["T32NR007969"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,7,11]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This study aims to leverage natural language processing (NLP) and machine learning clustering analyses to (1) identify co-occurring symptoms of patients undergoing catheter ablation for atrial fibrillation (AF) and (2) describe clinical and sociodemographic correlates of symptom clusters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a cross-sectional retrospective analysis using electronic health records data. Adults who underwent AF ablation between 2010 and 2020 were included. Demographic, comorbidity and medication information was extracted using structured queries. Ten AF symptoms were extracted from unstructured clinical notes (n=13\u2009416) using a validated NLP pipeline (F-score=0.81). We used the unsupervised machine learning approach known as Ward\u2019s hierarchical agglomerative clustering to characterise and identify subgroups of patients representing different clusters. Fisher\u2019s exact tests were used to investigate subgroup differences based on age, gender, race and heart failure (HF) status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 1293 patients were included in our analysis (mean age 65.5 years, 35.2% female, 58% white). The most frequently documented symptoms were dyspnoea (64%), oedema (62%) and palpitations (57%). We identified six symptom clusters: generally symptomatic, dyspnoea and oedema, chest pain, anxiety, fatigue and palpitations, and asymptomatic (reference). The asymptomatic cluster had a significantly higher prevalence of male, white and comorbid HF patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We applied NLP and machine learning to a large dataset to identify symptom clusters, which may signify latent biological underpinnings of symptom experiences and generate implications for clinical care. AF patients\u2019 symptom experiences vary widely. Given prior work showing that AF symptoms predict adverse outcomes, future work should investigate associations between symptom clusters and postablation outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002385","type":"journal-article","created":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T12:32:52Z","timestamp":1691152372000},"page":"e002385","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Characterising symptom clusters in patients with atrial fibrillation undergoing catheter ablation"],"prefix":"10.1136","volume":"10","author":[{"given":"Mollie","family":"Hobensack","sequence":"first","affiliation":[{"name":"Columbia University School of Nursing, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Columbia University School of Nursing, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Scharp","sequence":"additional","affiliation":[{"name":"Columbia University School of Nursing, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Volodarskiy","sequence":"additional","affiliation":[{"name":"Cardiology, NewYork-Presbyterian Queens Hospital, Flushing, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Slotwiner","sequence":"additional","affiliation":[{"name":"Cardiology, NewYork-Presbyterian Queens Hospital, Flushing, New York, USA"},{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6264-6320","authenticated-orcid":false,"given":"Meghan","family":"Reading Turchioe","sequence":"additional","affiliation":[{"name":"Columbia University School of Nursing, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,8,4]]},"reference":[{"key":"2025081710453971000_10.2.e002385.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.008201"},{"key":"2025081710453971000_10.2.e002385.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht280"},{"key":"2025081710453971000_10.2.e002385.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.001303"},{"key":"2025081710453971000_10.2.e002385.4","first-page":"1422","article-title":"Symptoms in atrial fibrillation: a contemporary review and future directions","volume":"9","author":"Heidt","year":"2016","journal-title":"J Atr Fibrillation"},{"key":"2025081710453971000_10.2.e002385.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.069450"},{"key":"2025081710453971000_10.2.e002385.6","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.jpainsymman.2011.09.017","article-title":"Concordance between patient reports of cancer-related symptoms and medical records documentation","volume":"44","author":"Sikorskii","year":"2012","journal-title":"J Pain Symptom Manage"},{"key":"2025081710453971000_10.2.e002385.7","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.jacep.2020.10.016","article-title":"Symptom under-recognition of atrial fibrillation patients in consideration for catheter ablation: a report from the Kics-AF Registry","volume":"7","author":"Katsumata","year":"2021","journal-title":"JACC Clin Electrophysiol"},{"key":"2025081710453971000_10.2.e002385.8","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.119.007414","article-title":"Catheter ablation versus medical therapy for atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials","volume":"12","author":"Asad","year":"2019","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2025081710453971000_10.2.e002385.9","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocy173"},{"key":"2025081710453971000_10.2.e002385.10","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1177\/1474515118778445","article-title":"Atrial fibrillation symptom clusters and associated clinical characteristics and outcomes: a cross-sectional secondary data analysis","volume":"17","author":"Streur","year":"2018","journal-title":"Eur J Cardiovasc Nurs"},{"key":"2025081710453971000_10.2.e002385.11","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2021-319769"},{"key":"2025081710453971000_10.2.e002385.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2019.01.024"},{"key":"2025081710453971000_10.2.e002385.13","unstructured":"Social Deprivation Index (SDI) . Robert Graham center. 2023. Available: https:\/\/www.graham-center.org\/maps-data-tools\/social-deprivation-index.html"},{"key":"2025081710453971000_10.2.e002385.14","first-page":"583","article-title":"Nimbleminer: an open-source nursing-sensitive natural language processing system based on word embedding","volume":"37","author":"Topaz","year":"2019","journal-title":"Comput Inform Nurs"},{"key":"2025081710453971000_10.2.e002385.15","doi-asserted-by":"crossref","first-page":"e173","DOI":"10.1161\/CIR.0000000000001089","article-title":"State of the science: the relevance of symptoms in cardiovascular disease and research: a scientific statement from the American Heart Association","volume":"146","author":"Jurgens","year":"2022","journal-title":"Circulation"},{"key":"2025081710453971000_10.2.e002385.16","unstructured":"Abstract 13012: atrial fibrillation symptom improvement following de novo catheter ablation: Trajectories and predictors of symptom resolution [Circulation]. Available: https:\/\/www.ahajournals.org\/doi\/abs\/10.1161\/circ.146.suppl_1.13012"},{"key":"2025081710453971000_10.2.e002385.17","doi-asserted-by":"publisher","DOI":"10.1007\/s00357-014-9161-z"},{"key":"2025081710453971000_10.2.e002385.18","doi-asserted-by":"crossref","unstructured":"Greene D , Cunningham P , Mayer R . Unsupervised learning and clustering. Cogn Technol 2008;51. doi:10.1007\/978-3-540-75171-7","DOI":"10.1007\/978-3-540-75171-7_3"},{"key":"2025081710453971000_10.2.e002385.19","doi-asserted-by":"publisher","DOI":"10.1093\/sysbio\/45.3.380"},{"key":"2025081710453971000_10.2.e002385.20","doi-asserted-by":"publisher","DOI":"10.1109\/TPAMI.1979.4766909"},{"key":"2025081710453971000_10.2.e002385.21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/03610927408827101","article-title":"A Dendrite method foe cluster analysis","volume":"3","author":"Calinski","year":"1974","journal-title":"Comm in Stats - Theory & Methods"},{"key":"2025081710453971000_10.2.e002385.22","doi-asserted-by":"publisher","DOI":"10.1016\/0377-0427(87)90125-7"},{"key":"2025081710453971000_10.2.e002385.23","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/1467-9868.00293","article-title":"Estimating the number of clusters in a data set via the gap statistic","volume":"63","author":"Tibshirani","year":"2001","journal-title":"J R Stat Soc B Stat"},{"key":"2025081710453971000_10.2.e002385.24","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v061.i06"},{"key":"2025081710453971000_10.2.e002385.25","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1093\/eurjcn\/zvac078","article-title":"\"Replace uncertainty with information\": shared decision-making and decision quality surrounding catheter ablation for atrial fibrillation","volume":"22","author":"Reading Turchioe","year":"2023","journal-title":"Eur J Cardiovasc Nurs"},{"key":"2025081710453971000_10.2.e002385.26","first-page":"530","article-title":"Agreement between patient-reported symptoms and their documentation in the medical record","volume":"14","author":"Pakhomov","year":"2008","journal-title":"Am J Manag Care"},{"key":"2025081710453971000_10.2.e002385.27","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ijcard.2022.08.021","article-title":"Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation","volume":"367","author":"Hermans","year":"2022","journal-title":"Int J Cardiol"},{"key":"2025081710453971000_10.2.e002385.28","first-page":"1390","article-title":"Symptom\/rhythm correlation with patient owned device: insights into practice and challenges","volume":"9","author":"Shurrab","year":"2016","journal-title":"J Atr Fibrillation"},{"key":"2025081710453971000_10.2.e002385.29","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.4022\/jafib.1514","article-title":"Excellent symptom rhythm correlation in patients with palpitations using a novel smartphone based event recorder","volume":"10","author":"Newham","year":"2017","journal-title":"J Atr Fibrillation"},{"key":"2025081710453971000_10.2.e002385.30","doi-asserted-by":"publisher","DOI":"10.1097\/JCN.0b013e31820019b9"},{"key":"2025081710453971000_10.2.e002385.31","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.001303"},{"key":"2025081710453971000_10.2.e002385.32","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euu151"},{"key":"2025081710453971000_10.2.e002385.33","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.4198","article-title":"An unsupervised machine learning approach to evaluating the association of symptom clusters with adverse outcomes among older adults with advanced cancer: a secondary analysis of a randomized clinical trial","volume":"6","author":"Xu","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2025081710453971000_10.2.e002385.34","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1111\/jan.15498","article-title":"The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care","volume":"79","author":"Song","year":"2023","journal-title":"J Adv Nurs"},{"key":"2025081710453971000_10.2.e002385.35","doi-asserted-by":"publisher","DOI":"10.1097\/JCN.0b013e31826620fa"},{"key":"2025081710453971000_10.2.e002385.36","article-title":"Catheter ablation for atrial fibrillation with heart failure","volume":"379","author":"Marrouche","year":"2018","journal-title":"N Engl J Med"},{"key":"2025081710453971000_10.2.e002385.37","doi-asserted-by":"publisher","DOI":"10.1111\/pace.12420"},{"key":"2025081710453971000_10.2.e002385.38","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1584"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2023-002385","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:45:49Z","timestamp":1755452749000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2023-002385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,8,4]]},"published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1136\/openhrt-2023-002385"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2023-002385","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8]]}}}