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Ren J, Wang H, Lai S, Shao Y, Che H, Xue Z, Qi X, Zhang S, Dai J, Wang S, Li K, Gan W, Si Q. Machine learning-based model to predict composite thromboembolic events among Chinese elderly patients with atrial fibrillation. BMC Cardiovasc Disord 2024; 24:420. [PMID: 39134969 PMCID: PMC11321189 DOI: 10.1186/s12872-024-04082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 07/30/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE Accurate prediction of survival prognosis is helpful to guide clinical decision-making. The aim of this study was to develop a model using machine learning techniques to predict the occurrence of composite thromboembolic events (CTEs) in elderly patients with atrial fibrillation(AF). These events encompass newly diagnosed cerebral ischemia events, cardiovascular events, pulmonary embolism, and lower extremity arterial embolism. METHODS This retrospective study included 6,079 elderly hospitalized patients (≥ 75 years old) with AF admitted to the People's Liberation Army General Hospital in China from January 2010 to June 2022. Random forest imputation was used for handling missing data. In the descriptive statistics section, patients were divided into two groups based on the occurrence of CTEs, and differences between the two groups were analyzed using chi-square tests for categorical variables and rank-sum tests for continuous variables. In the machine learning section, the patients were randomly divided into a training dataset (n = 4,225) and a validation dataset (n = 1,824) in a 7:3 ratio. Four machine learning models (logistic regression, decision tree, random forest, XGBoost) were trained on the training dataset and validated on the validation dataset. RESULTS The incidence of composite thromboembolic events was 19.53%. The Least Absolute Shrinkage and Selection Operator (LASSO) method, using 5-fold cross-validation, was applied to the training dataset and identified a total of 18 features that exhibited a significant association with the occurrence of CTEs. The random forest model outperformed other models in terms of area under the curve (ACC: 0.9144, SEN: 0.7725, SPE: 0.9489, AUC: 0.927, 95% CI: 0.9105-0.9443). The random forest model also showed good clinical validity based on the clinical decision curve. The Shapley Additive exPlanations (SHAP) showed that the top five features associated with the model were history of ischemic stroke, high triglyceride (TG), high total cholesterol (TC), high plasma D-dimer, age. CONCLUSIONS This study proposes an accurate model to stratify patients with a high risk of CTEs. The random forest model has good performance. History of ischemic stroke, age, high TG, high TC and high plasma D-Dimer may be correlated with CTEs.
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Affiliation(s)
- Jiefeng Ren
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Haijun Wang
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Song Lai
- Department of the Third Health Care, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yi Shao
- Health Management Center, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250012, Shandong, China
| | - Hebin Che
- Medical Big Data Research Center, Chinese PLA General Hospital, Fuxing Road 28#, Haidian district, Beijing, 100853, China
| | - Zaiyao Xue
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Xinlian Qi
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Sha Zhang
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Jinkun Dai
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Beijing Goodwill Hessian Health Technology, Dongcheng District, Beijing, 100007, China
| | - Sai Wang
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Beijing Goodwill Hessian Health Technology, Dongcheng District, Beijing, 100007, China
| | - Kunlian Li
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Beijing Goodwill Hessian Health Technology, Dongcheng District, Beijing, 100007, China
| | - Wei Gan
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Beijing Goodwill Hessian Health Technology, Dongcheng District, Beijing, 100007, China
| | - Quanjin Si
- Department of the Third Health Care, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
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Putaala J, Teppo K, Halminen O, Haukka J, Tiili P, Jaakkola J, Karlsson E, Linna M, Mustonen P, Kinnunen J, Kiviniemi T, Aro A, Hartikainen J, Airaksinen JK, Lehto M. Ischemic Stroke Temporally Associated With New-Onset Atrial Fibrillation: A Population-Based Registry-Linkage Study. Stroke 2024; 55:122-130. [PMID: 38063017 PMCID: PMC10734779 DOI: 10.1161/strokeaha.123.044448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Limited data exist on the temporal relationship between new-onset atrial fibrillation (AF) and ischemic stroke and its impact on patients' clinical characteristics and mortality. METHODS A population-based registry-linkage database includes all patients with new-onset AF in Finland from 2007 to 2018. Ischemic stroke temporally associated with AF (ISTAF) was defined as an ischemic stroke occurring within ±30 days from the first AF diagnosis. Clinical factors associated with ISTAF were studied with logistic regression and 90-day survival with Cox proportional hazards analysis. RESULTS Among 229 565 patients with new-onset AF (mean age, 72.7 years; 50% female), 204 774 (89.2%) experienced no ischemic stroke, 12 209 (5.3%) had past ischemic stroke >30 days before AF, and 12 582 (5.8%) had ISTAF. The annual proportion of ISTAF among patients with AF decreased from 6.0% to 4.8% from 2007 to 2018. Factors associated positively with ISTAF were higher age, lower education level, and alcohol use disorder, whereas vascular disease, heart failure, chronic kidney disease cancer, and psychiatric disorders were less probable with ISTAF. Compared with patients without ischemic stroke and those with past ischemic stroke, ISTAF was associated with ≈3-fold and 1.5-fold risks of death (adjusted hazard ratios, 2.90 [95% CI, 2.76-3.04] and 1.47 [95% CI, 1.39-1.57], respectively). The 90-day survival probability of patients with ISTAF increased from 0.79 (95% CI, 0.76-0.81) in 2007 to 0.89 (95% CI, 0.87-0.91) in 2018. CONCLUSIONS ISTAF depicts the prominent temporal clustering of ischemic strokes surrounding AF diagnosis. Despite having fewer comorbidities, patients with ISTAF had worse, albeit improving, survival than patients with a history of or no ischemic stroke. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04645537. URL: https://www.encepp.eu; Unique identifier: EUPAS29845.
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Affiliation(s)
- Jukka Putaala
- Department of Neurology (J.P., P.T., J.K.), Helsinki University Hospital and University of Helsinki, Finland
| | - Konsta Teppo
- Heart Center, Turku University Hospital and University of Turku, Finland (K.T., J.J., P.M., T.K., K.E.J.A.)
| | - Olli Halminen
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland (O.H., M. Linna)
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Finland (J. Haukka)
| | - Paula Tiili
- Department of Neurology (J.P., P.T., J.K.), Helsinki University Hospital and University of Helsinki, Finland
| | - Jussi Jaakkola
- Department of Neurology (J.P., P.T., J.K.), Helsinki University Hospital and University of Helsinki, Finland
| | | | - Miika Linna
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland (O.H., M. Linna)
| | - Pirjo Mustonen
- Heart Center, Turku University Hospital and University of Turku, Finland (K.T., J.J., P.M., T.K., K.E.J.A.)
| | - Janne Kinnunen
- Department of Neurology (J.P., P.T., J.K.), Helsinki University Hospital and University of Helsinki, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Finland (K.T., J.J., P.M., T.K., K.E.J.A.)
| | - Aapo Aro
- Heart and Lung Center (A.A.), Helsinki University Hospital and University of Helsinki, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital and University of Eastern Finland, Finland (J. Hartikainen)
| | - Juhani K.E. Airaksinen
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland (O.H., M. Linna)
| | - Mika Lehto
- University of Helsinki, Finland (E.K., M. Lehto)
- Department of Internal Medicine, Jorvi Hospital and Helsinki University Hospital, Espoo, Finland (M. Lehto)
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Djuric I, Dzudovic B, Subotic B, Dzudovic J, Matijasevic J, Benic M, Salinger S, Mitevska I, Kos L, Kovacevic-Preradovic T, Simovic S, Miloradovic V, Savicic T, Bozovic B, Bulatovic N, Kafedzic S, Neskovic AN, Kocev N, Marinković J, Obradovic S. New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men. Diagnostics (Basel) 2023; 13:diagnostics13111829. [PMID: 37296681 DOI: 10.3390/diagnostics13111829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. METHODS In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The severity of PE was assessed using the European Society of Cardiology (ESC) mortality risk model. Patients were allocated into three groups according to their electrocardiography recordings taken during hospitalization: sinus rhythm, new-onset paroxysmal AF, and persistent/permanent AF. The association between the types of AF and all-cause hospital mortality was tested using regression models and net reclassification index (NRI) and integrated discrimination index (IDI) statistics with respect to sex. RESULTS There were no differences between the frequencies of the types of AF between men and women: 8.1% vs. 9.1% and 7.5% vs. 7.5% (p = 0.766) for paroxysmal and persistent/permanent AF, respectively. We found that the rates of paroxysmal AF significantly increased across the mortality risk strata in both sexes. Among the types of AF, the presence of paroxysmal AF had a predictive value for all-cause hospital mortality independent of mortality risk and age in women only (adjusted HR, 2.072; 95% CI, 1.274-3.371; p = 0.003). Adding paroxysmal AF to the ESC risk model did not improve the reclassification of patient risk for the prediction of all-cause mortality, but instead enhanced the discriminative power of the existing model in women only (NRI, not significant; IDI, 0.022 (95% CI, 0.004-0.063); p = 0.013). CONCLUSION The occurrence of paroxysmal AF in female patients with acute PE has predictive value for all-cause hospital mortality independent of age and mortality risk.
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Affiliation(s)
- Ivica Djuric
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Boris Dzudovic
- Clinic of Emergency Internal Medicine, Military Medical Academy, 11000 Belgrade, Serbia
- School of Medicine Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
| | - Bojana Subotic
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jelena Dzudovic
- National Poison Control Center, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
- School of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Marija Benic
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, University of Nis, 18000 Nis, Serbia
| | - Irena Mitevska
- Clinic of Cardiology, School of Medicine, University of Skopje, 1000 Skopje, North Macedonia
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Stefan Simovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Tanja Savicic
- Department for Internal Medicine, General Hospital Pancevo, 26000 Pancevo, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
- School of Medicine Podgorica, University of Podgorica, 81000 Podgorica, Montenegro
| | - Srdjan Kafedzic
- Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
- School of Medicine Belgrade, University of Belgrade, 11000 Beograd, Serbia
| | - Nikola Kocev
- Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
| | - Jelena Marinković
- Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
| | - Slobodan Obradovic
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
- School of Medicine Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
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Noubiap JJ, Nyaga UF, Middeldorp ME, Fitzgerald JL, Ariyaratnam JP, Thomas G, Sanders P. Frequency and prognostic significance of atrial fibrillation in acute pulmonary embolism: A pooled analysis. Respir Med 2022; 199:106862. [DOI: 10.1016/j.rmed.2022.106862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/08/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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