High-Risk Prediction of Cardiovascular Diseases via Attention-Based Deep Neural Networks

Research on Artificial-Intelligence-Assisted Medicine: A Survey on Medical Artificial Intelligence

With the improvement of economic conditions and the increase in living standards, people's attention in regard to health is also continuously increasing. They are beginning to place their hopes on machines, expecting artificial intelligence (AI) to provide a more humanized medical environment and personalized services, thus greatly expanding the supply and bridging the gap between resource supply and demand. With the development of IoT technology, the arrival of the 5G and 6G communication era, and the enhancement of computing capabilities in particular, the development and application of AI-assisted healthcare have been further promoted. Currently, research on and the application of artificial intelligence in the field of medical assistance are continuously deepening and expanding. AI holds immense economic value and has many potential applications in regard to medical institutions, patients, and healthcare professionals. It has the ability to enhance medical efficiency, reduce healthcare costs, improve the quality of healthcare services, and provide a more intelligent and humanized service experience for healthcare professionals and patients. This study elaborates on AI development history and development timelines in the medical field, types of AI technologies in healthcare informatics, the application of AI in the medical field, and opportunities and challenges of AI in the field of medicine. The combination of healthcare and artificial intelligence has a profound impact on human life, improving human health levels and quality of life and changing human lifestyles.

Attention-Based Deep Learning Model for Prediction of Major Adverse Cardiovascular Events in Peritoneal Dialysis Patients

Major adverse cardiovascular events (MACE) encompass pivotal cardiovascular outcomes such as myocardial infarction, unstable angina, and cardiovascular-related mortality. Patients undergoing peritoneal dialysis (PD) exhibit specific cardiovascular risk factors during the treatment, which can escalate the likelihood of cardiovascular events. Hence, the prediction and key factor analysis of MACE have assumed paramount significance for peritoneal dialysis patients. Current pathological methodologies for prognosis prediction are not only costly but also cumbersome in effectively processing electronic health records (EHRs) data with high dimensionality, heterogeneity, and time series. Therefore in this study, we propose the CVEformer, an attention-based neural network designed to predict MACE and analyze risk factors. CVEformer leverages the self-attention mechanism to capture temporal correlations among time series variables, allowing for weighted integration of variables and estimation of the probability of MACE. CVEformer first captures the correlations among heterogeneous variables through attention scores. Then, it analyzes the correlations within the time series data to identify key risk variables and predict the probability of MACE. When trained and evaluated on data from a large cohort of peritoneal dialysis patients across multiple centers, CVEformer outperforms existing models in terms of predictive performance.

PARSE: A personalized clinical time-series representation learning framework via abnormal offsets analysis

BACKGROUND AND OBJECTIVE

Clinical risk prediction of patients is an important research issue in the field of healthcare, which is of great significance for the diagnosis, treatment and prevention of diseases. In recent years, a large number of deep learning-based methods have been proposed for clinical prediction by mining relevant features of patients' health condition from historical Electronic Health Records (EHRs) data. However, most of these existing methods only focus on discovering the time series characteristics of physiological indexes such as laboratory tests and physical examinations, and fail to comprehensively consider the deviation degree of these physiological indexes from the normal range and their stability, thus greatly limiting the prediction performance.

METHODS

We propose a personalized clinical time-series representation learning framework via abnormal offsets analysis named PARSE for clinical risk prediction. In PARSE, while extracting relevant temporal features from the original EHR data, we further capture relevant features of abnormal condition as complementary information from the absolute offset of each physiological index's observed values from its normal value and the relative offset between each physiological index's observed values in two adjacent time steps. Finally, an adaptive fusion module is introduced to effectively integrate the above features to obtain the personalized patient's representations for clinical risk prediction.

RESULTS

We conduct an in-hospital mortality prediction task on two public real-world datasets. PARSE achieves the highest F1 scores of 48.1% and 40.3%, outperforming the state-of-the-art methods with a boost of 2.4% and 6.2% on two datasets respectively. Furthermore, the results of ablation experiments demonstrate that the two abnormal offsets and the proposed adaptive fusion method are contributing.

CONCLUSIONS

PARSE can better extract the risk-related information from the EHRs data and improve the personalization of the patients' representations. Each part of PARSE improves the final prediction performance independently.

Detection of Cardiovascular Disease from Clinical Parameters Using a One-Dimensional Convolutional Neural Network

Heart disease is a significant public health problem, and early detection is crucial for effective treatment and management. Conventional and noninvasive techniques are cumbersome, time-consuming, inconvenient, expensive, and unsuitable for frequent measurement or diagnosis. With the advance of artificial intelligence (AI), new invasive techniques emerging in research are detecting heart conditions using machine learning (ML) and deep learning (DL). Machine learning models have been used with the publicly available dataset from the internet about heart health; in contrast, deep learning techniques have recently been applied to analyze electrocardiograms (ECG) or similar vital data to detect heart diseases. Significant limitations of these datasets are their small size regarding the number of patients and features and the fact that many are imbalanced datasets. Furthermore, the trained models must be more reliable and accurate in medical settings. This study proposes a hybrid one-dimensional convolutional neural network (1D CNN), which uses a large dataset accumulated from online survey data and selected features using feature selection algorithms. The 1D CNN proved to show better accuracy compared to contemporary machine learning algorithms and artificial neural networks. The non-coronary heart disease (no-CHD) and CHD validation data showed an accuracy of 80.1% and 76.9%, respectively. The model was compared with an artificial neural network, random forest, AdaBoost, and a support vector machine. Overall, 1D CNN proved to show better performance in terms of accuracy, false negative rates, and false positive rates. Similar strategies were applied for four more heart conditions, and the analysis proved that using the hybrid 1D CNN produced better accuracy.

LGTRL-DE: Local and Global Temporal Representation Learning with Demographic Embedding for in-hospital mortality prediction

Predicting the patient's in-hospital mortality from the historical Electronic Medical Records (EMRs) can assist physicians to make clinical decisions and assign medical resources. In recent years, researchers proposed many deep learning methods to predict in-hospital mortality by learning patient representations. However, most of these methods fail to comprehensively learn the temporal representations and do not sufficiently mine the contextual knowledge of demographic information. We propose a novel end-to-end approach based on Local and Global Temporal Representation Learning with Demographic Embedding (LGTRL-DE) to address the current issues for in-hospital mortality prediction. LGTRL-DE is enabled by (1) a local temporal representation learning module that captures the temporal information and analyzes the health status from a local perspective through a recurrent neural network with the demographic initialization and the local attention mechanism; (2) a Transformer-based global temporal representation learning module that extracts the interaction dependencies among clinical events; (3) a multi-view representation fusion module that fuses temporal and static information and generates the final patient's health representations. We evaluate our proposed LGTRL-DE on two public real-world clinical datasets (MIMIC-III and e-ICU). Experimental results show that LGTRL-DE achieves an area under receiver operating characteristic curve of 0.8685 and 0.8733 on the MIMIC-III and e-ICU datasets, respectively, outperforming state-of-the-art approaches.

An efficient and low complex model for optimal RBM features with weighted score-based ensemble multi-disease prediction

Multi-disease prediction is regarded as the capacity to simultaneously identify various diseases that are expected to be affected an individual at a certain period. These multiple diseases are seemed to be at various progression levels and need to be detected in the patient at the time of clinical visits. Diverse studies in the literature have included the predictive models for particular diseases yet, it is unable to notice humans with multiple diseases since humans are mostly suffered not only from a single disease but also from multiple diseases. Hence, this article aims to implement a novel multi-disease prediction model using an ensemble learning approach with deep features. The required data for the multi-disease prediction is collected from the standard datasets. Then, the collected data are given into the "Deep Belief Network (DBN)" approach, where the features are obtained from the RBM layers. These RBM features are tuned with the help of Deviation-based Hybrid Grasshopper Barnacles Mating Optimization (D-HGBMO) for improving the prediction performance. The optimized RBM features are considered in the ensemble learning model named Ensemble, in which the multi-disease prediction is performed with "Deep Neural Network (DNN), Extreme Learning Machine (ELM), and Long Short Term Memory." The predicted score from three classifiers is used in the optimized weighted score and thresholding-based final prediction using the same D-HGBMO for determining the accurate multi-disease prediction results. The experimental results show the effective performance of the proposed model by comparing it with the existing classifiers with the help of different quantitative measures.

Multi-modal fusion model for predicting adverse cardiovascular outcome post percutaneous coronary intervention

Background.Clinical medicine relies heavily on the synthesis of information and data from multiple sources. However, often simple feature concatenation is used as a strategy for developing a multimodal machine learning model in the cardiovascular domain, and thus the models are often limited by pre-selected features and moderate accuracy.Method.We proposed a two-branched joint fusion model for fusing the 12-lead electrocardiogram (ECG) signal data with clinical variables from the electronic medical record (EMR) in an end-to-end deep learning architecture. The model follows the joint fusion scheme and learns complementary information from ECG and EMR. Retrospective data from the Mayo Clinic Health Systems across four sites for patients that underwent percutaneous coronary intervention (PCI) were obtained. Model performance was assessed by area under the receiver-operating characteristics (AUROC) and Delong's test.Results.The final cohort included 17,356 unique patients with a mean age of 67.2 ± 12.6 year (mean ± std) and 9,163 (52.7%) were male. The joint fusion model outperformed the ECG time-domain model with statistical margin. The model with clinical data obtained the highest AUROC for all-cause mortality (0.91 at 6 months) but the joint fusion model outperformed for cardiovascular outcomes - heart failure hospitalization and ischemic stroke with a significant margin (Delong's p < 0.05).Conclusion.To the best of our knowledge, this is the first study that developed a deep learning model with joint fusion architecture for the prediction of post-PCI prognosis and outperformed machine learning models developed using traditional single-source features (clinical variables or ECG features). Adding ECG data with clinical variables did not improve prediction of all-cause mortality as may be expected, but the improved performance of related cardiac outcomes shows that the fusion of ECG generates additional value.

MERGE: A Multi-graph Attentive Representation learning framework integrating Group information from similar patients

It is an important research task in the field of medical big data to predict patient's future health status according to the historical temporal Electronic Health Records (EHRs). Most of the existing deep learning-based medical prediction methods only focus on the patient's individual information. However, due to the sparseness and low quality of EHR data, individual clinical records of single patient often cannot provide complete health information, which severely limits the accuracy of the prediction models. In this paper, we propose a Multi-graph attEntive Representation learning framework integrating Group information from similar patiEnts(MERGE) for medical prediction. In this framework, while capturing the individual patient's temporal characteristics through the individual representation learning module, the group representation leaning module is used to learn group representations of similar patients from different aspects as a supplement, thereby effectively improving the accuracy of patients' representation. We evaluate our method on the MIMIC-III dataset for the task of in-hospital mortality prediction and Xiangya dataset for cardiovascular diseases (CVDs) prediction. The experimental results show that MERGE outperforms the state-of-the-art methods.

CATNet: Cross-event attention-based time-aware network for medical event prediction

Medical event prediction (MEP) is a fundamental task in the healthcare domain, which needs to predict medical events, including medications, diagnosis codes, laboratory tests, procedures, outcomes, and so on, according to historical medical records of patients. Many researchers have tried to build MEP models to overcome the challenges caused by the heterogeneous and irregular temporal characteristics of EHR data. However, most of them consider the heterogenous and temporal medical events separately and ignore the correlations among different types of medical events, especially relations between heterogeneous historical medical events and target medical events. In this paper, we propose a novel neural network based on attention mechanism called Cross-event Attention-based Time-aware Network (CATNet) for MEP. It is a time-aware, event-aware and task-adaptive method with the following advantages: 1) modeling heterogeneous information and temporal information in a unified way and considering irregular temporal characteristics locally and globally respectively, 2) taking full advantage of correlations among different types of events via cross-event attention. Experiments on two public datasets (MIMIC-III and eICU) show CATNet outperforms other state-of-the-art methods on various MEP tasks. The source code of CATNet is released at https://github.com/sherry6247/CATNet.git.

Time Series Prediction Using Deep Learning Methods in Healthcare

Traditional Machine Learning (ML) methods face unique challenges when applied to healthcare predictive analytics. The high-dimensional nature of healthcare data necessitates labor-intensive and time-consuming processes when selecting an appropriate set of features for each new task. Furthermore, ML methods depend heavily on feature engineering to capture the sequential nature of patient data, oftentimes failing to adequately leverage the temporal patterns of medical events and their dependencies. In contrast, recent Deep Learning (DL) methods have shown promising performance for various healthcare prediction tasks by specifically addressing the high-dimensional and temporal challenges of medical data. DL techniques excel at learning useful representations of medical concepts and patient clinical data as well as their nonlinear interactions from high-dimensional raw or minimally-processed healthcare data.

In this paper we systematically reviewed research works that focused on advancing deep neural networks to leverage patient structured time series data for healthcare prediction tasks. To identify relevant studies, we searched MEDLINE, IEEE, Scopus, and ACM digital library for relevant publications through November 4 th , 2021. Overall, we found that researchers have contributed to deep time series prediction literature in ten identifiable research streams: DL models, missing value handling, addressing temporal irregularity, patient representation, static data inclusion, attention mechanisms, interpretation, incorporation of medical ontologies, learning strategies, and scalability. This study summarizes research insights from these literature streams, identifies several critical research gaps, and suggests future research opportunities for DL applications using patient time series data.

Multi-channel Fusion LSTM for Medical Event Prediction using HERs

Automatic medical event prediction (MEP), e.g. diagnosis prediction, medication prediction, using electronic health records (EHRs) is a popular research direction in health informatics. In many cases, MEP relies on the determinations from different types of medical events, which demonstrates the heterogeneous nature of EHRs. However, most existing methods for MEP fail to distinguishingly model the type of event that is highly associated with the prediction task, i.e. task-wise event, which usually plays a more significant role than other events. In this paper, we proposed a Long Short-Term Memory network (LSTM)-based method for MEP, named Multi-Channel Fusion LSTM (MCF-LSTM), which models the correlations between different types of medical events using multiple network channels. To this end, we designed a task-wise fusion module, in which a gated network is applied to select how much information can be transferred between events. Furthermore, the irregular temporal interval between adjacent medical visits is also modeled in an individual channel, which is combined with other events in a unified manner. We compared MCF-LSTM with state-of-the-art methods on four MEP tasks on two public datasets: MIMIC-III and eICU. Experimental results show that MCF-LSTM achieves promising results on AUC(receiver operating characteristic curve), AUPR (area under the precision-recall curve), and top-k recall, and outperforms other methods with high stability.

Time-Aware Multi-Type Data Fusion Representation Learning Framework for Risk Prediction of Cardiovascular Diseases

Predicting the future risk of cardiovascular diseases from the historical Electronic Health Records (EHRs) is a significant research task in personalized healthcare fields. In recent years, many deep neural network-based methods have emerged, which model patient disease progression by capturing the temporal patterns in sequential visit data. However, existing methods usually cannot effectively integrate the features of heterogeneous clinical data, and do not fully consider the impact of patients age and irregular time interval between consecutive medical records on the patients disease development. To address these challenges, we propose a Time-Aware Multi-type Data fUsion Representation learning framework (TAMDUR) for CVDs risk prediction. In this framework, we design a time-aware decay function, which is based on the patients age and the elapsed time between visits, to model the disease progression pattern. A parallel combination of Bi LSTM and CNN is constructed to respectively learn the temporal and non-temporal features from various types of clinical data. Finally, a multi-type data fusion representation layer based on self-attention is utilized to integrate various features and their correlations to obtain the final patient representation. We evaluate our model on a real medical dataset, and the experimental results demonstrate that TAMDUR outperforms the state-of-the-art approaches.

A hybrid method of recurrent neural network and graph neural network for next-period prescription prediction

Electronic health records (EHRs) have been widely used to help physicians to make decisions by predicting medical events such as diseases, prescriptions, outcomes, and so on. How to represent patient longitudinal medical data is the key to making these predictions. Recurrent neural network (RNN) is a popular model for patient longitudinal medical data representation from the view of patient status sequences, but it cannot represent complex interactions among different types of medical information, i.e., temporal medical event graphs, which can be represented by graph neural network (GNN). In this paper, we propose a hybrid method of RNN and GNN, called RGNN, for next-period prescription prediction from two views, where RNN is used to represent patient status sequences, and GNN is used to represent temporal medical event graphs. Experiments conducted on the public MIMIC-III ICU data show that the proposed method is effective for next-period prescription prediction, and RNN and GNN are mutually complementary.

An Effective Convolutional Neural Network for Classifying Red Blood Cells in Malaria Diseases

Malaria is one of the epidemics that can cause human death. Accurate and rapid diagnosis of malaria is important for treatment. Due to the limited number of data and human factors, the prediction performance and reliability of traditional classification methods are often affected. In this study, we propose an efficient and novel classification network named Attentive Dense Circular Net (ADCN) which based on Convolutional Neural Networks (CNN). The ADCN is inspired by the ideas of residual and dense networks and combines with the attention mechanism. We train and evaluate our proposed model on a publicly available red blood cells (RBC) dataset and compare ADCN with several well-established CNN models. Compared to other best performing CNN model in our experiments, ADCN shows superiority in all performance criteria such as accuracy (97.47% vs 94.61%), sensitivity (97.86% vs 95.20%) and specificity (97.07% vs 92.87%). Finally, we discuss the obtained results and analyze the difficulties of RBCs classification.

PESM: predicting the essentiality of miRNAs based on gradient boosting machines and sequences

Background

MicroRNAs (miRNAs) are a kind of small noncoding RNA molecules that are direct posttranscriptional regulations of mRNA targets. Studies have indicated that miRNAs play key roles in complex diseases by taking part in many biological processes, such as cell growth, cell death and so on. Therefore, in order to improve the effectiveness of disease diagnosis and treatment, it is appealing to develop advanced computational methods for predicting the essentiality of miRNAs.

Result

In this study, we propose a method (PESM) to predict the miRNA essentiality based on gradient boosting machines and miRNA sequences. First, PESM extracts the sequence and structural features of miRNAs. Then it uses gradient boosting machines to predict the essentiality of miRNAs. We conduct the 5-fold cross-validation to assess the prediction performance of our method. The area under the receiver operating characteristic curve (AUC), F-measure and accuracy (ACC) are used as the metrics to evaluate the prediction performance. We also compare PESM with other three competing methods which include miES, Gaussian Naive Bayes and Support Vector Machine.

Conclusion

The results of experiments show that PESM achieves the better prediction performance (AUC: 0.9117, F-measure: 0.8572, ACC: 0.8516) than other three computing methods. In addition, the relative importance of all features also further shows that newly added features can be helpful to improve the prediction performance of methods.