Temporal affiliation of hip fracture subphenotypes with the danger of MACE within the within-individual evaluation utilizing SCCS. Credit score: Nature Communications (2024). DOI: 10.1038/s41467-024-48713-3
A analysis workforce within the Division of Pharmacology and Pharmacy, LKS School of Medication, the College of Hong Kong (HKUMed), discovered that hip fractures not solely end in each bodily and psychological accidents, however can also induce opposed cardiovascular occasions. Particularly, hip fracture sufferers with pre-existing cardiac circumstances are related to a considerably increased threat of cardiovascular occasions (CVEs) and mortality, poorer prognosis, and higher well being service utilization.
The analysis employed massive information and synthetic intelligence (AI) to uncover hidden scientific traits of hip fracture sufferers of various ethnicities, primarily based on the digital well being information from Hong Kong and the UK (U.Okay.) of greater than 100,000 sufferers with hip fractures.
The findings may improve the present administration of hip fracture sufferers and supply precious insights into precision drugs in hip fracture sufferers. The examine has been revealed in Nature Communications.
The all-cause mortality price for hip fracture sufferers in Hong Kong is roughly 17%, considerably increased than that for breast, thyroid and prostate most cancers sufferers. CVEs are the main explanation for mortality amongst hip fracture sufferers, accounting for 33% of deaths.
Present analysis has discovered an affiliation between hip fractures and an elevated threat of CVEs, similar to coronary heart failure and myocardial infarction. Nevertheless, in hip fracture care, there’s a noticeable lack of emphasis on managing sufferers’ CVE threat.
Hip fractures typically require surgical procedure and can lead to postoperative cardiac problems. Even after accounting for these problems, there may be a right away elevated threat of CVEs following hip fractures. Nevertheless, contemplating the varied scientific traits of hip fracture sufferers, the mechanisms underlying this temporal affiliation are advanced and stay largely unexplored.
The HKUMed analysis workforce used AI to establish distinct clusters or subphenotypes of hip fracture sufferers primarily based on their scientific profiles. The workforce discovered three clusters within the Hong Kong cohort, characterised primarily by comparatively wholesome people (66%), these with metabolic-related illnesses (21.4%), and people with a historical past of congestive coronary heart failure or arrhythmia (12.6%).
The workforce discovered that the comparatively wholesome cluster exhibited a decrease threat of CVEs than the opposite two clusters. The cluster with metabolic-related illnesses had about twice the danger of main opposed cardiovascular occasions (MACEs) hospitalization inside 180 days of hip fracture.
Conversely, the cluster with a historical past of congestive coronary heart failure or arrhythmia had a major five-fold elevated threat of MACE hospitalization in the identical interval. And the all-cause mortality threat and unplanned hospital visits of this cluster had been twice as excessive as these of wholesome people with fractures, along with longer hospital stays.
The findings spotlight the significance of CVE threat administration in hip fracture care and the necessity to tackle the danger of hip fracture in sufferers with congestive coronary heart failure or arrhythmia. Moreover, this variation underscores the necessity to transfer past typical administration of hip fracture sufferers to extra customized administration methods, which can contain shut monitoring, well timed interventions, and the prioritization of well being care assets for hip fracture sufferers with a excessive CVE threat. This shift is essential for bettering the prognosis of hip fracture sufferers.
The workforce additionally discovered a considerably elevated threat of MACEs (93% enhance) inside 60 days after hip fracture utilizing the self-controlled case collection technique. This means that hip fracture alone may contribute to a short-term elevated threat of MACE, and this threat is additional heightened by the presence of pre-existing cardiac circumstances and different comorbidities. The danger decreased in the course of the subsequent post-hip fracture threat interval of 61–180 days. There have been comparable findings within the U.Okay. cohort.
Professor Cheung Ching-lung, Affiliate Professor within the Division of Pharmacology and Pharmacy, HKUMed, commented, “Vascular calcification is a known risk factor for CVEs. Bones serve as a vital calcium repository in the body; the suddenly raised blood calcium after fractures may increase the risk of stroke and cardiovascular disease. Therefore, prompt management of CVE risk following a hip fracture is very important.”
“Many people are unaware of the serious complications and mortality risks associated with fractures,” added Professor Cheung. “Our analysis illustrates that hip fractures might set off or worsen CVEs.
“Leveraging AI, we categorized the subphenotypes of hip fracture sufferers and revealed that people with a background of congestive coronary heart failure or arrhythmia are at increased threat of experiencing CVEs following hip fractures.
“These findings can facilitate the introduction of tailored treatments for hip fracture patients, thereby mitigating the likelihood of post-fracture complications and mortality. They also pave the way for the development of more precise and fitting clinical strategies for hip fracture patients in the future.”
Extra info:
Warrington W. Q. Hsu et al, Unveiling distinctive scientific phenotypes of hip fracture sufferers and the temporal affiliation with cardiovascular occasions, Nature Communications (2024). DOI: 10.1038/s41467-024-48713-3
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The College of Hong Kong
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Hip fractures linked to fivefold enhance in cardiovascular occasion threat in sufferers with coronary heart failure (2025, January 10)
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