Abstract
Cardiovascular events are the leading cause of death among hip fracture patients. This study aims to identify subphenotypes of hip fracture patients and investigate their association with incident cardiovascular events, all-cause mortality, and health service utilisation in Hong Kong and the United Kingdom populations. By the latent class analysis, we show three distinct clusters in the Hong Kong cohort (n = 78,417): Cluster 1 has cerebrovascular and hypertensive diseases, hyperlipidemia, and diabetes; Cluster 2 has congestive heart failure; Cluster 3 consists of relatively healthy patients. Compared to Cluster 3, higher risks of major adverse cardiovascular events are observed in Cluster 1 (hazard ratio 1.97, 95% CI 1.83 to 2.12) and Cluster 2 (hazard ratio 4.06, 95% CI 3.78 to 4.35). Clusters 1 and 2 are also associated with a higher risk of mortality, more unplanned accident and emergency visits and longer hospital stays. Self-controlled case series analysis shows a significantly elevated risk of major adverse cardiovascular events within 60 days post-hip fracture. Similar associations are observed in the United Kingdom cohort (n = 27,948). Pre-existing heart failure is identified as a unique subphenotype associated with poor prognosis after hip fractures.
| Original language | English |
|---|---|
| Article number | 4353 |
| Number of pages | 12 |
| Journal | Nature Communications |
| Volume | 15 |
| Issue number | 1 |
| Early online date | 22 May 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 22 May 2024 |
Bibliographical note
Copyright © The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/Data Access Statement
The data used in this study cannot be shared with the public due to third-party use restrictions and patient confidentiality concerns. The HK CDARS EHR database is directly under the control of the Hong Kong Hospital Authority. Local academic institutions, government departments, or non-governmental organisations can apply for accessto CDARS data through Hong Kong Hospital Authority Data Sharing Portal (https://www3.ha.org.hk/data). The detailed application procedure can be found at https://www3.ha.org.hk/data/Provision/ApplicationProcedure. The UK THIN, a Cegedim EHR Database, is licensed by IQVIA. It is available for researchers from academic, public
health, research establishment, charitable, commercial and regulatory bodies through purchase. Information on IQVIA Medical Research Data (IMRD) which incorporated the UK THIN data, can be found at https://www.iqvia.com/locations/united-kingdom/information-for-members-of-the-public/medical-research-data. Applications to access
the UK THIN data can be made via https://www.the-health-improvement-network.com/