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

Coordinated vs. liberal market HRM: the impact of institutionalization on multinational firms

The impact of institutionalized contexts on the HRM activities of multinational firms has become a focus of increasing attention in recent literature. However, theories of how different types of business systems or market economies may influence HRM, and the impact of context on multinational corporations (MNCs) operating under these different conditions are still not fully tested. In this paper the influence of the extent of institutional embeddedness of different national contexts (based on varieties of capitalism theory) on the HRM activities of MNCs is explored through the use of extensive survey data from four countries: the UK, Germany, the Netherlands and Sweden. Evidence is found of differences in HRM practices between foreign- and domestic-owned MNCs, as well as between MNCs and domestic organizations. Although less than expected, the restricted amount of leeway within a coordinated economy also appears to have differential effects on the various HRM practices explored in these foreign and domestic organizations

Talking across borders : successful re-entry in different strands of re-entry literature

The processes of re-entering a society after an international move have been studied in several fields. In this article, we argue that the existing differences in conceptualizations of a “successful re-entry” for different returning groups are created by particular social, political or theoretical ideas about mobility, which lead to biases in the understanding of re-entry processes and influence support practices for returning groups. A critical analysis of the conceptualization of successful re-entry of two extreme cases of returning people who both play to the interests of institutions that seek successful re-entry, namely returned refugees and asylum seekers on the one hand and repatriates on the other, enables us to bring these assumptions to the fore. Our analysis reveals how the permeation of economic and spatial understanding and the absence of temporal and relational understanding distorts insights into re-entry processes and creates blind spots in support practices for returning populations