Endocrine Abstracts

Major adverse cardiac events (MACE) are the leading cause of death among hip fracture patients. This study aimed to: (1) identify hip fracture subphenotypes using LCA and (2) evaluate the prognosis of the hip fracture subphenotypes on CVE-related outcomes in two extensive hip fracture cohorts from Hong Kong (HK CDARS; n=78,417) and the United Kingdom (UK THIN; n=27,948), employing both the conventional cohort (between-individual comparison) design and the self-controlled case series (SCCS; within-individual comparison) design. The latent class analysis (LCA) revealed three distinct clusters in the HK cohort: Cluster 1 had cerebrovascular and hypertensive diseases, hyperlipidemia, and diabetes; Cluster 2 had congestive heart failure; Cluster 3 consisted of relatively healthy patients. In the UK THIN dataset, Cluster 1 consisted of a high prevalence of CVE including coronary heart disease, congestive heart failure, and arrhythmia and conduction disorders, and with a higher prevalence of most clinical conditions studied when compared with the relatively healthy Cluster 2. In the HK cohort, the risk of 180-day all-cause mortality and MACE were significantly higher in Clusters 1 (all-cause mortality: HR 1.35, 95% CI 1.28 to 1.42; MACE: HR 1.97, 95% CI 1.83 to 2.12) and Cluster 2 (all-cause mortality: HR 2.22, 95% CI 2.10 to 2.34; MACE: HR 4.06, 95% CI 3.78 to 4.35) compared to Cluster 3. For the secondary outcomes, both Clusters 1 and 2 were associated with a higher number of hospital visits, A&E visits, and total length of hospital stays in the 180-day period after hip fracture. In the between-individual analysis, an immediate risk of overall MACE was observed in the Clusters 1 and 2 in the HK cohort, using the relatively healthy cluster as the reference. SCCS analysis (the within-individual analysis) showed a significantly elevated risk of MACE within 60 days post-hip fracture. Similar associations were observed in the UK cohort in all analyses. In conclusion, this study identified distinct subphenotypes of hip fracture in both the Hong Kong and UK older adult populations using LCA. Temporal associations with MACE were observed in all hip fracture patient clusters. Notably, heart failure consistently emerged as a key characteristic associated with poor prognosis in hip fracture patients. Personalised care of hip fracture patients, considering their specific subphenotypes, is required to prevent MACE.