Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

A review of Capoeta tinca, with descriptions of two new species from Turkey (Teleostei: Cyprinidae)

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Risk of invasiveness of non-native aquatic species in the eastern Mediterranean region under current and projected climate conditions

Human-induced biological introductions pose a major threat to global biodiversity, and this is especially frequent in the eastern Mediterranean region, which is a globally important biodiversity hotspot area of high conservation value. To predict at which level introduced species in this region might become invasive under current and projected climate conditions, 232 non-native aquatic organisms were screened using the Aquatic Species Invasiveness Screening Kit. Based on receiver operative characteristic curve analysis, thresholds were identified to distinguish between low, medium and high risk species. The "top invasive" (very high risk) species identified were: brown bullhead Ameiurus nebulosus, blue crab Callinectes sapidus, gibel carp Carassius gibelio, Philippine catfish Clarias batrachus, Chinese mitten crab Eriocheir sinensis, bluespotted cornetfish Fistularia commersonii, silver carp Hypophthalmichthys molitrix, silver-cheeked toadfish Lagocephalus sceleratus, half-smooth golden pufferfish Lagocephalus spadiceus, Suez pufferfish Lagocephalus suezensis, signal crayfish Pacifastacus leniusculus, fathead minnow Pimephales promelas, channeled applesnail Pomacea canaliculata, red swamp crayfish Procambarus clarkii, devil firefish Pterois miles and European catfish Silurus glanis. The risk of being invasive of more than half of the screened species increased after taking global warming predictions into account, and several species considered to be globally invasive (cf. high risk) were classified as posing only a medium risk for the eastern Mediterranean region. Region-specific risk screenings, as implemented in this study, are therefore essential for setting priorities in preventative management for the conservation of key biodiversity hotspots and the optimal allocation of resources in view of full risk assessment for the species identified as (very) high risk