{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T06:22:05Z","timestamp":1787638925490,"version":"build-2736575974"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute heart failure (AHF) is a highly heterogeneous clinical syndrome, posing challenges for risk stratification and management. Phenotype-based classification using unsupervised clustering may provide insights beyond conventional approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed a nationwide, prospective, multicenter registry of patients hospitalized with AHF. Baseline demographic characteristics, clinical variables, laboratory findings, and echocardiographic parameters obtained at index hospitalization were used for unsupervised clustering. K-means clustering was applied, and the optimal number of clusters was determined based on internal validation metrics and clinical interpretability. Clinical characteristics, treatment patterns, and outcomes were compared across clusters. Cox proportional hazards models were used to evaluate the association between cluster membership and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 7,351 patients were classified into five distinct clinical phenotypes. The clusters demonstrated marked differences in baseline characteristics, comorbidity burden, hemodynamic profiles, and cardiac function. Treatment patterns, including guideline-directed medical therapy and supportive interventions, varied significantly across clusters. During follow-up, all-cause mortality differed significantly among clusters (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), with Clusters 2, 3, and 5 remaining independently associated with increased mortality compared with Cluster 1 after multivariable adjustment. Heart failure hospitalization also differed significantly across clusters (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), although differences were less pronounced after multivariable adjustment. The composite endpoint of all-cause mortality or heart failure hospitalization showed clear separation across clusters (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). In multivariable analysis, cluster membership remained independently associated with all-cause mortality and the composite endpoint.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large, nationwide cohort of patients with AHF, unsupervised clustering identified five clinically distinct phenotypes with significantly different characteristics, management patterns, and outcomes. These findings support the clinical relevance of phenotype-based classification and highlight its potential to enhance risk stratification and inform more personalized management strategies in AHF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1862519","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:34:34Z","timestamp":1787636074000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Distinct clinical phenotypes in acute heart failure identified by unsupervised clustering: a nationwide registry-based study"],"prefix":"10.3389","volume":"13","author":[{"given":"Bo Eun","family":"Park","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyungpook National University","place":["Daegu, Republic of Korea"]},{"name":"Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital","place":["Daegu, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Heon","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyungpook National University","place":["Daegu, Republic of Korea"]},{"name":"Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital","place":["Daegu, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eung Ju","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Woo","family":"Han","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University","place":["Hwaseong, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong-Mi","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung-Seop","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital","place":["Daegu, Republic of Korea"]},{"name":"Division of Cardiology, Department of Internal Medicine, Keimyung University School of Medicine","place":["Daegu, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju-Hee","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine","place":["Cheongju, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyo-Suk","family":"Ahn","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea","place":["Uijeongbu, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi-Seung","family":"Shin","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine","place":["Incheon, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Jai","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine","place":["Seoul, Republic of Korea"]},{"name":"Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Rang","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine","place":["Jinju, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Ok","family":"Jeong","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine","place":["Daejeon, Republic of Korea"]},{"name":"Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital","place":["Daejeon, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junho","family":"Hyun","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Asan Medical Center","place":["Seoul, Republic of Korea"]},{"name":"Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Oh","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Cardiovascular Institute, Samsung Medical Center","place":["Seoul, Republic of Korea"]},{"name":"Division of Cardiology, Department of Internal Medicine, Sungkyunkwan University School of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-Su","family":"Yoo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine","place":["Wonju, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok-Min","family":"Kang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine","place":["Seoul, Republic of Korea"]},{"name":"Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Ju","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine","place":["Seongnam, Republic of 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