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Zhang Y, Zhu X, Gao F, Yang S. Systematic Review and Critical Appraisal of Prediction Models for Readmission in Coronary Artery Disease Patients: Assessing Current Efficacy and Future Directions. Risk Manag Healthc Policy 2024; 17:549-557. [PMID: 38496372 PMCID: PMC10944133 DOI: 10.2147/rmhp.s451436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Coronary artery disease (CAD) patients frequently face readmissions due to suboptimal disease management. Prediction models are pivotal for detecting early unplanned readmissions. This review offers a unified assessment, aiming to lay the groundwork for enhancing prediction models and informing prevention strategies. Methods A search through five databases (PubMed, Web of Science, EBSCOhost, Embase, China National Knowledge Infrastructure) up to September 2023 identified studies on prediction models for coronary artery disease patient readmissions for this review. Two independent reviewers used the CHARMS checklist for data extraction and the PROBAST tool for bias assessment. Results From 12,457 records, 15 studies were selected, contributing 30 models targeting various CAD patient groups (AMI, CABG, ACS) from primarily China, the USA, and Canada. Models utilized varied methods such as logistic regression and machine learning, with performance predominantly measured by the c-index. Key predictors included age, gender, and hospital stay duration. Readmission rates in the studies varied from 4.8% to 45.1%. Despite high bias risk across models, several showed notable accuracy and calibration. Conclusion The study highlights the need for thorough external validation and the use of the PROBAST tool to reduce bias in models predicting readmission for CAD patients.
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Affiliation(s)
- Yunhao Zhang
- College of Nursing, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Xuejiao Zhu
- College of Nursing, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Fuer Gao
- College of Nursing, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Shulan Yang
- Department of Nursing, Zhejiang Hospital, Hangzhou, People’s Republic of China
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Rellum SR, Schuurmans J, van der Ven WH, Eberl S, Driessen AHG, Vlaar APJ, Veelo DP. Machine learning methods for perioperative anesthetic management in cardiac surgery patients: a scoping review. J Thorac Dis 2022; 13:6976-6993. [PMID: 35070381 PMCID: PMC8743411 DOI: 10.21037/jtd-21-765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/27/2021] [Indexed: 12/27/2022]
Abstract
Background Machine learning (ML) is developing fast with promising prospects within medicine and already has several applications in perioperative care. We conducted a scoping review to examine the extent and potential limitations of ML implementation in perioperative anesthetic care, specifically in cardiac surgery patients. Methods We mapped the current literature by searching three databases: MEDLINE (Ovid), EMBASE (Ovid), and Cochrane Library. Articles were eligible if they reported on perioperative ML use in the field of cardiac surgery with relevance to anesthetic practices. Data on the applicability of ML and comparability to conventional statistical methods were extracted. Results Forty-six articles on ML relevant to the work of the anesthesiologist in cardiac surgery were identified. Three main categories emerged: (I) event and risk prediction, (II) hemodynamic monitoring, and (III) automation of echocardiography. Prediction models based on ML tend to behave similarly to conventional statistical methods. Using dynamic hemodynamic or ultrasound data in ML models, however, shifts the potential to promising results. Conclusions ML in cardiac surgery is increasingly used in perioperative anesthetic management. The majority is used for prediction purposes similar to conventional clinical scores. Remarkable ML model performances are achieved when using real-time dynamic parameters. However, beneficial clinical outcomes of ML integration have yet to be determined. Nonetheless, the first steps introducing ML in perioperative anesthetic care for cardiac surgery have been taken.
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Affiliation(s)
- Santino R Rellum
- Department of Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Jaap Schuurmans
- Department of Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Ward H van der Ven
- Department of Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Susanne Eberl
- Department of Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Antoine H G Driessen
- Department of Cardiothoracic Surgery, Heart Center, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Denise P Veelo
- Department of Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
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Van Grootven B, Jepma P, Rijpkema C, Verweij L, Leeflang M, Daams J, Deschodt M, Milisen K, Flamaing J, Buurman B. Prediction models for hospital readmissions in patients with heart disease: a systematic review and meta-analysis. BMJ Open 2021; 11:e047576. [PMID: 34404703 PMCID: PMC8372817 DOI: 10.1136/bmjopen-2020-047576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/30/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the discrimination and calibration of clinical prediction models, identify characteristics that contribute to better predictions and investigate predictors that are associated with unplanned hospital readmissions. DESIGN Systematic review and meta-analysis. DATA SOURCE Medline, EMBASE, ICTPR (for study protocols) and Web of Science (for conference proceedings) were searched up to 25 August 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were eligible if they reported on (1) hospitalised adult patients with acute heart disease; (2) a clinical presentation of prediction models with c-statistic; (3) unplanned hospital readmission within 6 months. PRIMARY AND SECONDARY OUTCOME MEASURES Model discrimination for unplanned hospital readmission within 6 months measured using concordance (c) statistics and model calibration. Meta-regression and subgroup analyses were performed to investigate predefined sources of heterogeneity. Outcome measures from models reported in multiple independent cohorts and similarly defined risk predictors were pooled. RESULTS Sixty studies describing 81 models were included: 43 models were newly developed, and 38 were externally validated. Included populations were mainly patients with heart failure (HF) (n=29). The average age ranged between 56.5 and 84 years. The incidence of readmission ranged from 3% to 43%. Risk of bias (RoB) was high in almost all studies. The c-statistic was <0.7 in 72 models, between 0.7 and 0.8 in 16 models and >0.8 in 5 models. The study population, data source and number of predictors were significant moderators for the discrimination. Calibration was reported for 27 models. Only the GRACE (Global Registration of Acute Coronary Events) score had adequate discrimination in independent cohorts (0.78, 95% CI 0.63 to 0.86). Eighteen predictors were pooled. CONCLUSION Some promising models require updating and validation before use in clinical practice. The lack of independent validation studies, high RoB and low consistency in measured predictors limit their applicability. PROSPERO REGISTRATION NUMBER CRD42020159839.
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Affiliation(s)
- Bastiaan Van Grootven
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Research Foundation Flanders, Brussel, Belgium
| | - Patricia Jepma
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Corinne Rijpkema
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Lotte Verweij
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Mariska Leeflang
- Faculty of Science, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Joost Daams
- Medical Library, Amsterdam UMC Location AMC, Amsterdam, North Holland, Netherlands
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Public Health, University of Basel, Basel, Switzerland
| | - Koen Milisen
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, University Hospitals Leuven, Leuven, Belgium
- Department of Geriatric Medicine, KU Leuven - University of Leuven, Leuven, Belgium
| | - Bianca Buurman
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Faculty of Science, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
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An Evolutionary Computation Approach for Optimizing Multilevel Data to Predict Patient Outcomes. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:7174803. [PMID: 29744026 PMCID: PMC5878885 DOI: 10.1155/2018/7174803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/31/2018] [Indexed: 11/18/2022]
Abstract
Widespread adoption of electronic health records (EHR) and objectives for meaningful use have increased opportunities for data-driven predictive applications in healthcare. These decision support applications are often fueled by large-scale, heterogeneous, and multilevel (i.e., defined at hierarchical levels of specificity) patient data that challenge the development of predictive models. Our objective is to develop and evaluate an approach for optimally specifying multilevel patient data for prediction problems. We present a general evolutionary computational framework to optimally specify multilevel data to predict individual patient outcomes. We evaluate this method for both flattening (single level) and retaining the hierarchical predictor structure (multiple levels) using data collected to predict critical outcomes for emergency department patients across five populations. We find that the performance of both the flattened and hierarchical predictor structures in predicting critical outcomes for emergency department patients improve upon the baseline models for which only a single level of predictor—either more general or more specific—is used (p < 0.001). Our framework for optimizing the specificity of multilevel data improves upon more traditional single-level predictor structures and can readily be adapted to similar problems in healthcare and other domains.
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Freundlich RE, Maile MD, Hajjar MM, Habib JR, Jewell ES, Schwann T, Habib RH, Engoren M. Years of Life Lost After Complications of Coronary Artery Bypass Operations. Ann Thorac Surg 2016; 103:1893-1899. [PMID: 27938887 DOI: 10.1016/j.athoracsur.2016.09.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/08/2016] [Accepted: 09/12/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND We currently have an incomplete understanding of which postoperative complications after coronary artery bypass grafting (CABG) are associated with long-term death. The purpose of this study was to find the associations between complications and attributable death. METHODS Prospectively collected data on patient characteristics, risk factors, and complications of patients undergoing isolated CABG with 20-year follow-up were analyzed with a Cox regression model to calculate the overall hazard of dying associated with each postoperative complication. An individual's age and hazard of dying from each complication were then used to calculate years of life lost to each complication. RESULTS The postoperative mortality rate was 0.79% (69 of 8,773) at 30 days, 2.85% (250 of 8,773) at 180 days, and 6.38% (560 of 8,773) at 2 years. At a median follow-up of 9.8 years, 1,891 patients (21.6%) had died. Postoperative complications occurred in 3,438 patients (39.2%). Cardiac arrest (hazard ratio, 2.153), reoperation (hazard ratio, 1.679), and new dialysis (hazard ratio, 1.64) were the complications with the greatest hazard of death. After adjusting for complication incidence and patient age, cardiac arrest (703 years), reoperation (544 years), atrial fibrillation (470 years), and prolonged mechanical ventilation (371 years) were associated with the greatest number of years of life lost. CONCLUSIONS Acute cardiac arrest, reoperation for other cardiac reasons, new dialysis, atrial fibrillation, and prolonged mechanical ventilation are associated with the largest increase in attributable deaths. Prevention and treatment of these complications may improve mortality rates after cardiac operations.
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Affiliation(s)
- Robert E Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Michael D Maile
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Mark M Hajjar
- Department of Internal Medicine and Outcomes Research Unit, American University Beirut, Beirut, Lebanon
| | - Joseph R Habib
- Department of Internal Medicine and Outcomes Research Unit, American University Beirut, Beirut, Lebanon
| | - Elizabeth S Jewell
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Thomas Schwann
- Department of Surgery, University of Toledo, Toledo, Ohio
| | - Robert H Habib
- Department of Internal Medicine and Outcomes Research Unit, American University Beirut, Beirut, Lebanon
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan; Department of Anesthesiology, Mercy St. Vincent Medical Center, Toledo, Ohio
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Genetic Programming for the Downscaling of Extreme Rainfall Events on the East Coast of Peninsular Malaysia. ATMOSPHERE 2014. [DOI: 10.3390/atmos5040914] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Holmes JH. Methods and applications of evolutionary computation in biomedicine. J Biomed Inform 2014; 49:11-5. [PMID: 24874181 DOI: 10.1016/j.jbi.2014.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 12/20/2022]
Affiliation(s)
- John H Holmes
- Associate Professor of Medical Informatics in Epidemiology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, United States.
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Introduction to the special issue: papers from the Society for Complex Acute Illness (SCAI). J Clin Monit Comput 2014; 27:373-4. [PMID: 23760647 DOI: 10.1007/s10877-013-9485-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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