Characterising symptom clusters in patients with atrial fibrillation undergoing catheter ablation

• Published in: Open heart Vol. 10; no. 2; p. e002385
• Main Authors: Hobensack, Mollie, Zhao, Yihong, Scharp, Danielle, Volodarskiy, Alexander, Slotwiner, David, Reading Turchioe, Meghan
• Format: Journal Article
• Language: English
• Published: England British Cardiovascular Society 01.08.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Ablation; Adult; Age; Aged; Anticoagulants; Arrhythmias and Sudden Death; Asymptomatic; Atrial Fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - surgery; Cardiac arrhythmia; Catheter Ablation; Catheter Ablation - adverse effects; Catheters; Clinical decision making; Clustering; Comorbidity; Cross-Sectional Studies; Dyspnea; Electronic Health Records; Ethnicity; Female; Gender; Humans; Machine learning; Male; Natural language processing; Patients; Retrospective Studies; Sociodemographics; Socioeconomic factors; Syndrome; Catheter Ablation; Atrial Fibrillation; Electronic Health Records
• ISSN: 2053-3624; 2398-595X; 2053-3624
• DOI: 10.1136/openhrt-2023-002385

ObjectiveThis 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.MethodsWe 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=13 416) using a validated NLP pipeline (F-score=0.81). We used the unsupervised machine learning approach known as Ward’s hierarchical agglomerative clustering to characterise and identify subgroups of patients representing different clusters. Fisher’s exact tests were used to investigate subgroup differences based on age, gender, race and heart failure (HF) status.ResultsA 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.ConclusionsWe 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’ 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.