Advanced cardiovascular risk prediction in the emergency department: updating a clinical prediction model – a large database study protocol (original) (raw)
Related papers
International Journal of Cardiology, 2014
Rapid and accurate risk stratification of chest pain patients in the emergency department (ED) plays an important role in guiding appropriate disposition and early intervention so as to rapidly identify those with high risk of adverse coronary events. A conventional risk score for potential acute coronary syndromes (ACS) is the thrombolysis in myocardial infarction (TIMI) score [1]. The TIMI score was suggested to be a useful tool in the ED setting . Recent studies involving an undifferentiated population of ED chest pain patients reported increasing rates of death, acute myocardial infarction (AMI) and revascularization at 30 days with increasing TIMI scores .
Artificial Intelligence in Medicine, 2021
Introduction: The risk prediction of the occurrence of a clinical event is often based on conventional statistical procedures, through the implementation of risk score models. Recently, approaches based on more complex machine learning (ML) methods have been developed. Despite the latter usually have a better predictive performance, they obtain little approval from the physicians, as they lack interpretability and, therefore, clinical confidence. One clinical issue where both types of models have received great attention is the mortality risk prediction after acute coronary syndromes (ACS). Objective: We intend to create a new risk assessment methodology that combines the best characteristics of both risk score and ML models. More specifically, we aim to develop a method that, besides having a good performance, offers a personalized model and outcome for each patient, presents high interpretability, and incorporates an estimation of the prediction reliability which is not usually available. By combining these features in the same approach we expect that it can boost the confidence of physicians to use such a tool in their daily activity. Methods: In order to achieve the mentioned goals, a three-step methodology was developed: several rules were created by dichotomizing risk factors; such rules were trained with a machine learning classifier to predict the acceptance degree of each rule (the probability that the rule is correct) for each patient; that information was combined and used to compute the risk of mortality and the
Improving diagnosis of acute coronary syndromes in an emergency setting: A machine learning approach
Acute coronary syndrome (ACS) is the biggest people killer in the western world today. Despite well trained physicians and reliable diagnostic tools, diagnosing ACS early in the emergency departments (ED) remains a challenge. In this thesis we used machine learning, via logistic regression models and artificial neural network ensembles, to investigate the possibility of predicting ACS at an early stage using electrocardiogram data. Thorough comparisons were made to several expert physicians, currently working in the ED, to verify the models. In the context of neural networks we developed methods for the case based explanation of their decisions.
Machine Learning Improves Risk Stratification After Acute Coronary Syndrome
Scientific reports, 2017
The accurate assessment of a patient's risk of adverse events remains a mainstay of clinical care. Commonly used risk metrics have been based on logistic regression models that incorporate aspects of the medical history, presenting signs and symptoms, and lab values. More sophisticated methods, such as Artificial Neural Networks (ANN), form an attractive platform to build risk metrics because they can easily incorporate disparate pieces of data, yielding classifiers with improved performance. Using two cohorts consisting of patients admitted with a non-ST-segment elevation acute coronary syndrome, we constructed an ANN that identifies patients at high risk of cardiovascular death (CVD). The ANN was trained and tested using patient subsets derived from a cohort containing 4395 patients (Area Under the Curve (AUC) 0.743) and validated on an independent holdout set containing 861 patients (AUC 0.767). The ANN 1-year Hazard Ratio for CVD was 3.72 (95% confidence interval 1.04-14.3) ...
JACC: Cardiovascular Interventions, 2019
OBJECTIVES This study sought to determine whether machine learning can be used to better identify patients at risk for death or congestive heart failure (CHF) rehospitalization after percutaneous coronary intervention (PCI). BACKGROUND Contemporary risk models for event prediction after PCI have limited predictive ability. Machine learning has the potential to identify complex nonlinear patterns within datasets, improving the predictive power of models. METHODS We evaluated 11,709 distinct patients who underwent 14,349 PCIs between January 2004 and December 2013 in the Mayo Clinic PCI registry. Fifty-two demographic and clinical parameters known at the time of admission were used to predict in-hospital mortality and 358 additional variables available at discharge were examined to identify patients at risk for CHF readmission. For each event, we trained a random forest regression model (i.e., machine learning) to estimate the time-to-event. Eight-fold cross-validation was used to estimate model performance. We used the predicted time-to-event as a score, generated a receiver operating characteristic curve, and calculated the area under the curve (AUC). Model performance was then compared with a logistic regression model using pairwise comparisons of AUCs and calculation of net reclassification indices. RESULTS The predictive algorithm identified a high-risk cohort representing 2% of all patients who had an in-hospital mortality of 45.5% (95% confidence interval: 43.5% to 47.5%) compared with a risk of 2.1% for the general population (AUC: 0.925; 95% confidence interval: 0.92 to 0.93). Advancing age, CHF, and shock on presentation were the leading predictors for the outcome. A high-risk group representing 1% of all patients was identified with 30-day CHF rehospitalization of 8.1% (95% confidence interval: 6.3% to 10.2%). Random forest regression outperformed logistic regression for predicting 30-day CHF readmission (AUC: 0.90 vs. 0.85; p ¼ 0.003; net reclassification improvement: 5.14%) and 180-day cardiovascular death (AUC: 0.88 vs. 0.81; p ¼ 0.02; net reclassification improvement: 0.02%). CONCLUSIONS Random forest regression models (machine learning) were more predictive and discriminative than standard regression methods at identifying patients at risk for 180-day cardiovascular mortality and 30-day CHF rehospitalization, but not in-hospital mortality. Machine learning was effective at identifying subgroups at high risk for postprocedure mortality and readmission.
2020
Background: Chest pain represents one of the most common reasons for consultation in emergency medical services (EMS). A diagnostic strategy using objective and subjective information about the characteristics of chest pain has not been identified yet. Objective: The aim of this study was to evaluate the performance of a machine learning classifier as a tool for prediction of the risk for non-ST-segment elevation acute coronary syndrome (ACS) in patients consulting an EMS due to chest pain. Methods: A total of 161 patients consulting the EMS due to chest pain were analyzed. Both objective and subjective variables about the characteristics of chest pain were recorded using a machine learning classifier. Results: Mean age was 57.43±12 years, 72.7% were men and 17.4% had prior cardiovascular disease. Acute coronary syndrome was present in 57.8% of cases with an incidence of 29.8%. Among the latter 35% required percutaneous coronary intervention and 9.9% myocardial revascularization sur...
BMC Medical Informatics and Decision Making, 2006
Background Several models for prediction of acute coronary syndrome (ACS) among chest pain patients in the emergency department (ED) have been presented, but many models predict only the likelihood of acute myocardial infarction, or include a large number of variables, which make them less than optimal for implementation at a busy ED. We report here a simple statistical model for ACS prediction that could be used in routine care at a busy ED. Methods Multivariable analysis and logistic regression were used on data from 634 ED visits for chest pain. Only data immediately available at patient presentation were used. To make ACS prediction stable and the model useful for personnel inexperienced in electrocardiogram (ECG) reading, simple ECG data suitable for computerized reading were included. Results Besides ECG, eight variables were found to be important for ACS prediction, and included in the model: age, chest discomfort at presentation, symptom duration and previous hypertension, angina pectoris, AMI, congestive heart failure or PCI/CABG. At an ACS prevalence of 21% and a set sensitivity of 95%, the negative predictive value of the model was 96%. Conclusion The present prediction model, combined with the clinical judgment of ED personnel, could be useful for the early discharge of chest pain patients in populations with a low prevalence of ACS.