{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:52:22Z","timestamp":1791636742821,"version":"4.3.4"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Heart failure (HF) classification based on left ventricular ejection fraction (LVEF) inadequately captures HF heterogeneity, limiting phenotype\u2010specific therapies. While machine learning (ML) has been applied to HF with preserved ejection fraction, comprehensive approaches across the full LVEF spectrum remain scarce. This study aimed to identify HF phenogroups across the entire LVEF spectrum using unsupervised ML, moving beyond the LVEF\u2010centric and fragmented understanding of HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We analyzed 13\u2009238 patients with acute HF from a nationwide, multicenter Japanese cohort (JROADHF [Japanese Registry of Acute Decompensated Heart Failure]). Unsupervised latent class analysis identified phenogroups from 46 clinically important admission variables. The primary end point was the 5\u2010year composite of cardiovascular death or HF readmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Three ML\u2010based phenogroups emerged: (1) \u201cHF with congestion and lower output\u201d (n=2638), (2) \u201cHF with afterload mismatch\u201d (n=3462), and (3) \u201cHFpEF\u2010like HF\u201d (n=7138). ML\u2010derived groups stratified risk for the primary end point (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), whereas LVEF\u2010based classification did not (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.267). Compared with phenogroup 3, phenogroup 1 had a higher age\u2010adjusted risk by Cox regression model (hazard ratio [HR], 1.60 [95% CI, 1.49\u20131.71]) and phenogroup 2 had a lower risk (HR, 0.65 [95% CI, 0.60\u20130.70]). Notably, variable\u2010importance analysis by discriminative power for phenogroup assignment indicated that total bilirubin, left ventricular diastolic diameter, and hemoglobin rather than LVEF principally drove classification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Unsupervised ML identified novel HF phenogroups with distinct 5\u2010year outcomes. This framework moves beyond an LVEF\u2010centric paradigm, deepens understanding of HF pathophysiology, and may facilitate phenotype\u2010specific therapeutic development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.050615","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:06:38Z","timestamp":1791633998000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Advancing Heart Failure Classification Beyond Left Ventricular Ejection Fraction: Unsupervised Machine Learning Insights From the Japanese Nationwide Acute Decompensated Heart Failure Cohort: JROADHF"],"prefix":"10.1161","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0271-9324","authenticated-orcid":false,"given":"Atsushi","family":"Kyodo","sequence":"first","affiliation":[{"name":"Nara Medical University","place":["Kashihara, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0510-6923","authenticated-orcid":false,"given":"Yasuki","family":"Nakada","sequence":"additional","affiliation":[{"name":"Nara Medical University","place":["Kashihara, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0516-8753","authenticated-orcid":false,"given":"Kazutaka","family":"Nogi","sequence":"additional","affiliation":[{"name":"Nara Medical University","place":["Kashihara, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2816-4926","authenticated-orcid":false,"given":"Satomi","family":"Ishihara","sequence":"additional","affiliation":[{"name":"Nara Medical University","place":["Kashihara, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0656-3336","authenticated-orcid":false,"given":"Tomoya","family":"Ueda","sequence":"additional","affiliation":[{"name":"Nara Medical University","place":["Kashihara, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Tohyama","sequence":"additional","affiliation":[{"name":"Massachusetts Institute of Technology","place":["Cambridge, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3899-4405","authenticated-orcid":false,"given":"Nobuyuki","family":"Enzan","sequence":"additional","affiliation":[{"name":"Broad Institute of MIT and Harvard","place":["Cambridge, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9774-4513","authenticated-orcid":false,"given":"Shouji","family":"Matsushima","sequence":"additional","affiliation":[{"name":"Kyushu University","place":["Fukuoka, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Tsutsui","sequence":"additional","affiliation":[{"name":"International University of Health and Welfare","place":["Okawa, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2284-1970","authenticated-orcid":false,"given":"Shungo","family":"Hikoso","sequence":"additional","affiliation":[{"name":"Nara Medical University","place":["Kashihara, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.822"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.11.053"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz158"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz364"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2470"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2025.03.029"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.010637"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.008081"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1621"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2019.09.009"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(23)00065-1"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-20-0947"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2016.11.011"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2021-320270"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2169"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004710"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.14288"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.07.979"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.14368"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.72.364"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.13560"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.96.10.3294"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeae025"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2020.04.10"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-18-0073"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/circheartfailure.118.004962"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2015.08.015"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad276"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2918"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.126.050615","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:06:38Z","timestamp":1791633998000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.126.050615"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,10]]},"references-count":30,"alternative-id":["10.1161\/JAHA.126.050615"],"URL":"https:\/\/doi.org\/10.1161\/jaha.126.050615","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,10]]},"assertion":[{"value":"2026-03-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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