The following is a summary of “Using Latent Class Analysis to Identify Different Clinical Profiles Among Patients With Advanced Heart Failure,” published in the February 2023 issue of Pain Management by Blum, et al.
Palliative care is recommended by guidelines for patients with advanced heart failure (HF), however, due to a lack of specialists educated in palliative care, it was important to identify the individuals who were most affected by the condition. In a cohort of people with advanced HF, researchers looked for latent subgroups with differences in symptom load, functional status, and multimorbidity.
On the basis of baseline data from a trial enlisting patients with advanced HF, they conducted a latent class analysis (LCA). They selected functional status, the number of comorbidities, physical and psychological symptom load, and indications of HF severity as LCA input factors.
Two subgroups, Class A (352 [62.5%] and Class B (211 [37.5%]) formed from LCA among 563 individuals. When compared to Class B patients, individuals in Class A were less frequently assigned to NYHA classes III or IV (88.0% vs. 97.5%, P< 0.001). Only 25.9% of Class A patients reported difficulties performing activities of daily living (ADL), and almost none experienced clinically significant anxiety (0.4%) or depression (0.9%). They also had fewer symptoms and comorbidities. Every patient in Class B reported more than three symptoms, 92.6% of patients had some ADL impairment, and over a third of patients had anxiety or sadness (28.3% or 30.2%, respectively). Class B had a higher all-cause death rate after a year (18.5% vs. 12.5%, P = 0.047) than Class A.
They found a discrete cohort of advanced HF patients that may benefit most from palliative care measures. The grouping was defined by a confluence of high symptom burden, anxiety, depression, multimorbidity, and functional status impairment.