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Jiang H, Yan W, Han P, Zhang J, Miao H, Liang G, Luo X, Shen L, Liu Y, Qi L, Gong H, Dong Y, Lu J. The predictive value of CHA2DS2-VASc score on the prognosis of patients with atrial fibrillation based on a prospective cohort study. J Thorac Dis 2024; 16:3932-3943. [PMID: 38983168 PMCID: PMC11228718 DOI: 10.21037/jtd-24-737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
Background Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia encountered in clinical practice, and it is associated with an increased risk of mortality, stroke, and peripheral embolism. The risk of stroke in AF is heterogeneous and dependent on underlying clinical conditions included in current risk stratification schemes. Recently, the CHA2DS2-VASc score has been incorporated into guidelines to encompass common stroke risk factors observed in routine clinical practice. The aim of this study was to study the predictive value of CHA2DS2-VASc score on the prognosis of patients with AF to determine the correlation of major complications including cerebral infarction and intracranial hemorrhage in patients with AF with oral anticoagulant and antiplatelet aggregation drugs and to identify the risk factors for all-cause mortality. Methods A prospective study was conducted on 181 patients with AF who underwent physical examinations at Hai'an Qutang Central Hospital from January 2020 to December 2020. The patient's general condition, chronic disease history, CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 years, and sex category (female)] score, left ventricular ejection fraction (LVEF), lipid metabolism, and oral anticoagulant and antiplatelet aggregation medication during physical examination were recorded. By using telephone meetings to complete the follow-up, we tracked the patient's cerebral infarction, intracranial hemorrhage, and survival status within 2 years of follow-up, statistically analyzed the relationship between AF complications and medication, and grouped patients with AF based on the CHA2DS2-VASc score to evaluate its predictive ability for mortality outcomes in these patients. Results The patients were divided into four groups according to the medication situation, and the incidence of cerebral infarction in the combination group was significantly lower than that in the non-medication group (0.0% vs. 19.2%; P<0.01). The incidence of intracranial hemorrhage in the combination group was significantly higher than that in the non-drug group (13.8% vs. 0.0%; P<0.01). The logistic regression model indicated that patients with a history of cerebral infarction had an increased risk of death compared to those without a history of cerebral infarction [odds ratio (OR) =7.404; 95% confidence interval (CI): 2.255-24.309]. After grouping according to the CHA2DS2-VASc score, we found that there was a significant difference in the 2-year survival rate between patients with CHA2DS2-VASc score <5 and those with a score ≥5 (P<0.01). The characteristic curve analysis of the participants showed that the CHA2DS2-VASc score had good predictive ability for all-cause mortality in patients with AF (area under the curve =0.754), with a cutoff value of 4, a sensitivity of 62.50%, a specificity of 86.06%, and a 95% CI of 0.684-0.815. Conclusions The CHA2DS2-VASc score demonstrated high predictive value for all-cause mortality in patients with AF.
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Affiliation(s)
- Haiyan Jiang
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Wenxiao Yan
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Peixin Han
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of General Practice, Hai’an Qutang Central Hospital, Nantong, China
| | - Jie Zhang
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Hua Miao
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of Emergency Medicine, Rudong County People’s Hospital, Nantong, China
| | - Guiwen Liang
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Xinye Luo
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Lunan Shen
- Office of Inspection Work, Nantong Municipal Committee, the Communist Party of China, Nantong, China
| | - Yousheng Liu
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Lei Qi
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Hui Gong
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Yansong Dong
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Juying Lu
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
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Papadopoulou A, Harding D, Slabaugh G, Marouli E, Deloukas P. Prediction of atrial fibrillation and stroke using machine learning models in UK Biobank. Heliyon 2024; 10:e28034. [PMID: 38571586 PMCID: PMC10987914 DOI: 10.1016/j.heliyon.2024.e28034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Objective Atrial fibrillation (AF) is the most common cardiac arrythmia, and it is associated with increased risk for ischemic stroke, which is underestimated, as AF can be asymptomatic. The aim of this study was to develop optimal ML models for prediction of AF in the population, and secondly for ischemic stroke in AF patients. Methods To develop ML models for prediction of 1) AF in the general population and 2) ischemic stroke in patients with AF we constructed XGBoost, LightGBM, Random Forest, Deep Neural Network, Support Vector Machine and Lasso penalised logistic regression models using UK-Biobank's extensive real-world clinical data, questionnaires, as well as biochemical and genetic data, and their predictive performances were compared. Ranking and contribution of the different features was assessed by SHapley Additive exPlanations (SHAP) analysis. The clinical tool CHA2DS2-VASc for prediction of ischemic stroke among AF patients, was used for comparison to the best performing ML model. Findings The best performing model for AF prediction was LightGBM, with an area-under-the-roc-curve (AUROC) of 0.729 (95% confidence intervals (CI): 0.719, 0.738). The best performing model for ischemic stroke prediction in AF patients was XGBoost with AUROC of 0.631 (95% CI: 0.604, 0.657). The improved AUROC in the XGBoost model compared to CHA2DS2-VASc was statistically significant based on DeLong's test (p-value = 2.20E-06). In addition, the SHAP analysis showed that several peripheral blood biomarkers (e.g. creatinine, glycated haemoglobin, monocytes) were associated with ischemic stroke, which are not considered by CHA2DS2-VASc. Implications The best performing ML models presented have the potential for clinical use, but further validation in independent studies is required. Our results endorse the incorporation of some routinely measured blood biomarkers for ischemic stroke prediction in AF patients.
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Affiliation(s)
- Areti Papadopoulou
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel Harding
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Greg Slabaugh
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
- Digital Environment Research Institute, Queen Mary University of London, London, UK
| | - Eirini Marouli
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Digital Environment Research Institute, Queen Mary University of London, London, UK
| | - Panos Deloukas
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah, Saudi Arabia
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Chen Y, Gue Y, Calvert P, Gupta D, McDowell G, Azariah JL, Namboodiri N, Bucci T, Jabir A, Tse HF, Chao TF, Lip GYH, Bahuleyan CG. Predicting stroke in Asian patients with atrial fibrillation using machine learning: A report from the KERALA-AF registry, with external validation in the APHRS-AF registry. Curr Probl Cardiol 2024; 49:102456. [PMID: 38346609 DOI: 10.1016/j.cpcardiol.2024.102456] [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: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
Atrial fibrillation (AF) is a significant risk factor for stroke. Based on the higher stroke associated with AF in the South Asian population, we constructed a one-year stroke prediction model using machine learning (ML) methods in KERALA-AF South Asian cohort. External validation was performed in the prospective APHRS-AF registry. We studied 2101 patients and 83 were to patients with stroke in KERALA-AF registry. The random forest showed the best predictive performance in the internal validation with receiver operator characteristic curve (AUC) and G-mean of 0.821 and 0.427, respectively. In the external validation, the light gradient boosting machine showed the best predictive performance with AUC and G-mean of 0.670 and 0.083, respectively. We report the first demonstration of ML's applicability in an Indian prospective cohort, although the more modest prediction on external validation in a separate multinational Asian registry suggests the need for ethnic-specific ML models.
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Affiliation(s)
- Yang Chen
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ying Gue
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Garry McDowell
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jinbert Lordson Azariah
- Department of Clinical Research, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, India; Department of Research, Global Institute of Public Health, Trivandrum, India
| | - Narayanan Namboodiri
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy
| | - A Jabir
- Lisie Heart Institute, Ernakulam, India
| | - Hung Fat Tse
- Division of Cardiology, Department of Medicine, School of Clinical Medicine; Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Tze-Fan Chao
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, DK-9220, Denmark.
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Hamatani Y, Nishi H, Iguchi M, Esato M, Tsuji H, Wada H, Hasegawa K, Ogawa H, Abe M, Fukuda S, Akao M. Machine Learning Risk Prediction for Incident Heart Failure in Patients With Atrial Fibrillation. JACC. ASIA 2022; 2:706-716. [PMID: 36444329 PMCID: PMC9700042 DOI: 10.1016/j.jacasi.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/01/2022] [Accepted: 07/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little focus is placed on the risk stratification for, and prevention of, incident HF in patients with AF. OBJECTIVES This study aimed to construct and validate a machine learning (ML) prediction model for HF hospitalization in patients with AF. METHODS The Fushimi AF Registry is a community-based prospective survey of patients with AF in Fushimi-ku, Kyoto, Japan. We divided the data set of the registry into derivation (n = 2,383) and validation (n = 2,011) cohorts. An ML model was built to predict the incidence of HF hospitalization using the derivation cohort, and predictive ability was examined using the validation cohort. RESULTS HF hospitalization occurred in 606 patients (14%) during a median follow-up period of 4.4 years in the entire registry. Data of transthoracic echocardiography and biomarkers were frequently nominated as important predictive variables across all 6 ML models. The ML model based on a random forest algorithm using 7 variables (age, history of HF, creatinine clearance, cardiothoracic ratio on x-ray, left ventricular [LV] ejection fraction, LV end-systolic diameter, and LV asynergy) had high prediction performance (area under the receiver operating characteristics curve [AUC]: 0.75) and was significantly superior to the Framingham HF risk model (AUC: 0.67; P < 0.001). Based on Kaplan-Meier curves, the ML model could stratify the risk of HF hospitalization during the follow-up period (log-rank; P < 0.001). CONCLUSIONS The ML model revealed important predictors and helped us to stratify the risk of HF, providing opportunities for the prevention of HF in patients with AF.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hidehisa Nishi
- Division of Neurosurgery, St. Michael’s Hospital, Toronto, Canada
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masahiro Esato
- Department of Arrhythmia, Ogaki Tokushukai Hospital, Gifu, Japan
| | | | - Hiromichi Wada
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunichi Fukuda
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Zhou Z, Huang C, Fu P, Huang H, Zhang Q, Wu X, Yu Q, Sun Y. Prediction of in-hospital hypokalemia using machine learning and first hospitalization day records in patients with traumatic brain injury. CNS Neurosci Ther 2022; 29:181-191. [PMID: 36258296 PMCID: PMC9804086 DOI: 10.1111/cns.13993] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 02/06/2023] Open
Abstract
AIMS Hypokalemia is a common complication following traumatic brain injury, which may complicate treatment and lead to unfavorable outcomes. Identifying patients at risk of hypokalemia on the first day of admission helps to implement prophylactic treatment, reduce complications, and improve prognosis. METHODS This multicenter retrospective study was performed between January 2017 and December 2020 using the electronic medical records of patients admitted due to traumatic brain injury. A propensity score matching approach was adopted with a ratio of 1:1 to overcome overfitting and data imbalance during subgroup analyses. Five machine learning algorithms were applied to generate a best-performed prediction model for in-hospital hypokalemia. The internal fivefold cross-validation and external validation were performed to demonstrate the interpretability and generalizability. RESULTS A total of 4445 TBI patients were recruited for analysis and model generation. Hypokalemia occurred in 46.55% of recruited patients and the incidences of mild, moderate, and severe hypokalemia were 32.06%, 12.69%, and 1.80%, respectively. Hypokalemia was associated with increased mortality, while severe hypokalemia cast greater impacts. The logistic regression algorithm had the best performance in predicting decreased serum potassium and moderate-to-severe hypokalemia, with an AUC of 0.73 ± 0.011 and 0.74 ± 0.019, respectively. The prediction model was further verified using two external datasets, including our previous published data and the open-assessed Medical Information Mart for Intensive Care database. Linearized calibration curves showed no statistical difference (p > 0.05) with perfect predictions. CONCLUSIONS The occurrence of hypokalemia following traumatic brain injury can be predicted by first hospitalization day records and machine learning algorithms. The logistic regression algorithm showed an optimal predicting performance verified by both internal and external validation.
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Affiliation(s)
- Zhengyu Zhou
- Department of Anesthesia, Huashan HospitalFudan UniversityShanghaiChina
| | - Chiungwei Huang
- Health Consultation and Physical Examination Center, Zhongshan HospitalFudan UniversityShanghaiChina,Department of Neurosurgery, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Pengfei Fu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Hong Huang
- Information Center, Huashan HospitalFudan UniversityShanghaiChina
| | - Qi Zhang
- Information Center, Huashan HospitalFudan UniversityShanghaiChina
| | - Xuehai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina,National Center for Neurological DisordersShanghaiChina,Shanghai Key Laboratory of Brain Function Restoration and Neural RegenerationShanghaiChina,Neurosurgical Institute of Fudan UniversityShanghaiChina,Shanghai Clinical Medical Center of NeurosurgeryShanghaiChina
| | - Qiong Yu
- Department of Anesthesia, Huashan HospitalFudan UniversityShanghaiChina
| | - Yirui Sun
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina,National Center for Neurological DisordersShanghaiChina,Shanghai Key Laboratory of Brain Function Restoration and Neural RegenerationShanghaiChina,Neurosurgical Institute of Fudan UniversityShanghaiChina,Shanghai Clinical Medical Center of NeurosurgeryShanghaiChina
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