Heart disease remains the leading cause of death in the United States. Compared with risk assessment guidelines that require manual calculation of scores, machine learning-based prediction for disease outcomes such as mortality can be utilized to save time and improve prediction accuracy. This study built and evaluated various machine learning models to predict one-year mortality in patients diagnosed with acute myocardial infarction or post myocardial infarction syndrome in the MIMIC-III database. The results of the best performing shallow prediction models were compared to a deep feedforward neural network (Deep FNN) with back propagation. We included a cohort of 5436 admissions. Six datasets were developed and compared. The models applying Logistic Model Trees (LMT) and Simple Logistic algorithms to the combined dataset resulted in the highest prediction accuracy at 85.12% and the highest AUC at .901. In addition, other factors were observed to have an impact on outcomes as well.
Cluster analysis aims at separating patients into phenotypically heterogenous groups and defining therapeutically homogeneous patient subclasses. It is an important approach in data-driven disease classification and subtyping. Acute coronary syndrome (ACS) is a syndrome due to sudden decrease of coronary artery blood flow, where disease classification would help to inform therapeutic strategies and provide prognostic insights. Here we conducted outcome-driven cluster analysis of ACS patients, which jointly considers treatment and patient outcome as indicators for patient state. Multi-task neural network with attention was used as a modeling framework, including learning of the patient state, cluster analysis, and feature importance profiling. Seven patient clusters were discovered. The clusters have different characteristics, as well as different risk profiles to the outcome of in-hospital major adverse cardiac events. The results demonstrate cluster analysis using outcome-driven multi-task neural network as promising for patient classification and subtyping.
We describe our experience in the development of a probabilistic network for the diagnosis of acute cardiopulmonary diseases. A panel of expert physicians collaborated to specify the qualitative part, that is a directed acyclic graph defining a factorization of the joint probability distribution of domain variables. The quantitative part, that is the set of all conditional probability distributions defined by each factor, was estimated in the Bayesian paradigm: we applied a special formal representation, characterized by a low number of parameters and a parameterization intelligible for physicians, elicited the joint prior distribution of parameters from medical experts, and updated it by conditioning on a dataset of hospital patient records using Markov Chain Monte Carlo simulation. Refinement was cyclically performed until the probabilistic network provided satisfactory Concordance Index values for a selection of acute diseases and reasonable inference on six fictitious patient cases. The probabilistic network can be employed to perform medical diagnosis on a total of 63 diseases (38 acute and 25 chronic) on the basis of up to 167 patient findings.
A key challenge in reducing the burden of cardiovascular disease is matching patients to treatments that are most appropriate for them. Different cardiac assessment tools have been developed to address this goal. Recent research has focused on heart rate motifs, i.e., short-term heart rate sequences that are over- or under-represented in long-term electrocardiogram (ECG) recordings of patients experiencing cardiovascular outcomes, which provide novel and valuable information for risk stratification. However, this approach can leverage only a small number of motifs for prediction and results in difficult to interpret models. We address these limitations by identifying latent structure in the large numbers of motifs found in long-term ECG recordings. In particular, we explore the application of topic models to heart rate time series to identify functional sets of heart rate sequences and to concisely describe patients using task-independent features for various cardiovascular outcomes. We evaluate the approach on a large collection of real-world ECG data, and investigate the performance of topic mixture features for the prediction of cardiovascular mortality. The topics provided an interpretable representation of the recordings and maintained valuable information for clinical assessment when compared with motif frequencies, even after accounting for commonly used clinical risk scores.
Decision analysis and knowledge-based expert systems share some common goals. Both technologies are designed to improve human decision making; they attempt to do this by formalizing human expert knowledge so that it is amenable to mechanized reasoning. However, the technologies are based on rather different principles. Decision analysis is the application of the principles of decision theory supplemented with insights from the psychology of judgment. Expert systems, at least as we use this term here, involve the application of various logical and computational techniques of AI to the representation of human knowledge for automated inference.