Predicting Hospital Readmission in Heart Failure Patients in Iran: A Comparison of Various Machine Learning Methods

Predictive analytics for cardiovascular patient readmission and mortality: An explainable approach

BACKGROUND

Cardiovascular patients experience high rates of adverse outcomes following discharge from hospital, which may be preventable through early identification and targeted action. This study aimed to investigate the effectiveness and explainability of machine learning algorithms in predicting unplanned readmission and death in cardiovascular patients at 30 days and 180 days from discharge.

METHODS

Gradient boosting machines were trained and evaluated using data from hospital electronic medical records linked to hospital administrative and mortality data for 39,255 patients admitted to four hospitals in New South Wales, Australia between 2017 and 2021. Sociodemographic variables, admission history, and clinical information were used as potential predictors. The performance was compared to LASSO regression, as well as the HOSPITAL and LACE risk score indices. Important risk factors identified by the gradient-boosting machine model were explored using Shapley values.

RESULTS

The models performed well, especially for the mortality outcomes. Area under the receiver operating characteristic curve values were 0.70 for readmission and 0.87-0.90 for mortality using the full gradient boosting machine algorithms. Among the top predictors for 30-day and 180-day readmission were increased red cell distribution width, old age (especially above 80 years), high measured troponin and urea levels, not being married or in a relationship, and low albumin levels. For mortality, these included increased red cell distribution width, old age (especially older than 70 years), high measured troponin and urea levels, high neutrophil and monocyte counts, and low eosinophil and lymphocyte counts. The Shapley values gave clear insight into the dynamics of decision-tree-based models.

CONCLUSIONS

We demonstrated an explainable predictive algorithm to identify cardiovascular patients who are at high risk of readmission or death at discharge from the hospital and identified key risk factors.

The predictive power of data: machine learning analysis for Covid-19 mortality based on personal, clinical, preclinical, and laboratory variables in a case-control study

BACKGROUND AND PURPOSE

The COVID-19 pandemic has presented unprecedented public health challenges worldwide. Understanding the factors contributing to COVID-19 mortality is critical for effective management and intervention strategies. This study aims to unlock the predictive power of data collected from personal, clinical, preclinical, and laboratory variables through machine learning (ML) analyses.

METHODS

A retrospective study was conducted in 2022 in a large hospital in Abadan, Iran. Data were collected and categorized into demographic, clinical, comorbid, treatment, initial vital signs, symptoms, and laboratory test groups. The collected data were subjected to ML analysis to identify predictive factors associated with COVID-19 mortality. Five algorithms were used to analyze the data set and derive the latent predictive power of the variables by the shapely additive explanation values.

RESULTS

Results highlight key factors associated with COVID-19 mortality, including age, comorbidities (hypertension, diabetes), specific treatments (antibiotics, remdesivir, favipiravir, vitamin zinc), and clinical indicators (heart rate, respiratory rate, temperature). Notably, specific symptoms (productive cough, dyspnea, delirium) and laboratory values (D-dimer, ESR) also play a critical role in predicting outcomes. This study highlights the importance of feature selection and the impact of data quantity and quality on model performance.

CONCLUSION

This study highlights the potential of ML analysis to improve the accuracy of COVID-19 mortality prediction and emphasizes the need for a comprehensive approach that considers multiple feature categories. It highlights the critical role of data quality and quantity in improving model performance and contributes to our understanding of the multifaceted factors that influence COVID-19 outcomes.

Predicting the risk of mortality and rehospitalization in heart failure patients: A retrospective cohort study by machine learning approach

BACKGROUND

Heart failure (HF) is a global problem, affecting more than 26 million people worldwide. This study evaluated the performance of 10 machine learning (ML) algorithms and chose the best algorithm to predict mortality and readmission of HF patients by using The Fasa Registry on Systolic HF (FaRSH) database.

HYPOTHESIS

ML algorithms may better identify patients at increased risk of HF readmission or death with demographic and clinical data.

METHODS

Through comprehensive evaluation, the best-performing model was used for prediction. Finally, all the trained models were applied to the test data, which included 20% of the total data. For the final evaluation and comparison of the models, five metrics were used: accuracy, F1-score, sensitivity, specificity and Area Under Curve (AUC).

RESULTS

Ten ML algorithms were evaluated. The CatBoost (CAT) algorithm uses a series of decision tree models to create a nonlinear model, and this CAT algorithm performed the best of the 10 models studied. According to the three final outcomes from this study, which involved 2488 participants, 366 (14.7%) of the patients were readmitted to the hospital, 97 (3.9%) of the patients died within 1 month of the follow-up, and 342 (13.7%) of the patients died within 1 year of the follow-up. The most significant variables to predict the events were length of stay in the hospital, hemoglobin level, and family history of MI.

CONCLUSIONS

The ML-based risk stratification tool was able to assess the risk of 5-year all-cause mortality and readmission in patients with HF. ML could provide an explicit explanation of individualized risk prediction and give physicians an intuitive understanding of the influence of critical features in the model.

Longitudinal machine learning model for predicting systolic blood pressure in patients with heart failure

Objective

Systolic blood pressure (SBP) strongly indicates the prognosis of heart failure (HF) patients, as it is closely linked to the risk of death and readmission. Hence, maintaining control over blood pressure is a vital factor in the management of these patients. In order to determine significant variables associated with changes in SBP over time and assess the effectiveness of classical and machine learning models in predicting SBP, this study aimed to conduct a comparative analysis between the two.

Methods

This retrospective cohort study involved the analysis of data from 483 patients with HF who were admitted to Farshchian Heart Center located in Hamadan in the west of Iran, and hospitalized at least two times between October 2015 and July 2019. To predict SBP, we utilized a linear mixed-effects model (LMM) and mixed-effects least-square support vector regression (MLS-SVR). The effectiveness of both models was evaluated based on the mean absolute error and root mean squared error.

Results

The LMM analysis revealed that changes in SBP over time were significantly associated with sex, body mass index (BMI), sodium, time, and history of hypertension (P-value < 0.05). Furthermore, according to the MLS-SVR analysis, the four most important variables in predicting SBP were identified as history of hypertension, sodium, BMI, and triglyceride. In both the training and testing datasets, MLS-SVR outperformed LMM in terms of performance.

Conclusions

Based on our results, it appears that MLS-SVR has the potential to serve as a viable alternative to classical longitudinal models for predicting SBP in patients with HF.

Predicting polypharmacy in half a million adults in the Iranian population: comparison of machine learning algorithms

BACKGROUND

Polypharmacy (PP) is increasingly common in Iran, and contributes to the substantial burden of drug-related morbidity, increasing the potential for drug interactions and potentially inappropriate medications. Machine learning algorithms (ML) can be employed as an alternative solution for the prediction of PP. Therefore, our study aimed to compare several ML algorithms to predict the PP using the health insurance claims data and choose the best-performing algorithm as a predictive tool for decision-making.

METHODS

This population-based cross-sectional study was performed between April 2021 and March 2022. After feature selection, information about 550 thousand patients were obtained from National Center for Health Insurance Research (NCHIR). Afterwards, several ML algorithms were trained to predict PP. Finally, to assess the models' performance, the metrics derived from the confusion matrix were calculated.

RESULTS

The study sample comprised 554 133 adults with a median (IQR) age of 51 years (40 - 62) that nested in 27 cities within the Khuzestan province of Iran. Most of the patients were female (62.5%), married (63.5%), and employed (83.2%) during the last year. The prevalence of PP in all populations was about 36.0%. After performing the feature selection, out of 23 features, the number of prescriptions, Insurance coverage for prescription drugs, and hypertension were found as the top three predictors. Experimental results showed that Random Forest (RF) performed better than other ML algorithms with recall, specificity, accuracy, precision and F1-score of 63.92%, 89.92%, 79.99%, 63.92% and 63.92% respectively.

CONCLUSION

It was found that ML provides a reasonable level of accuracy in predicting polypharmacy. Therefore, the prediction models based on ML, especially the RF algorithm, performed better than other methods for predicting PP in Iranian people in terms of the performance criteria.

Prediction of Hepatitis disease using ensemble learning methods

OBJECTIVE

Hepatitis is one of the chronic diseases that can lead to liver cirrhosis and hepatocellular carcinoma, which cause deaths around the world. Hence, early diagnosis is needed to control, treat, and reduce the effects of this disease. This study's main goal was to compare the performance of traditional and ensemble learning methods for predicting hepatitis B virus (HBV), and hepatitis C virus (HCV). Also, important variables related to HBV and HCV were identified.

METHODS

This case-control study was conducted in Hamadan Province, in the west of Iran, between 2014 to 2019. It included 534 subjects (267 cases and 267 controls). The bagging, random forest, AdaBoost, and logistic regression were used for predicting HBV and HCV. These methods' performance was evaluated using accuracy.

RESULTS

According to the results, the accuracy of bagging, random forest, Adaboost, and logistic regression were 0.65 ± 0.03, 0.66 ± 0.03, 0.62 ± 0.04, and 0.64 ± 0.03, respectively, with random forest showing the best performance for predicting HBV. This method showed that ALT was the most important variable for predicting HBV. The the accuracy of random forest was 0.77±0.03 for predicting HCV. Also, the random forest showed that the order of variable importance has belonged to AST, ALT, and age for predicting HCV.

CONCLUSION

This study showed that random forest performed better than other methods for predicting HBV and HCV.

The relationship of family functioning and family health with hospital readmission in patients with heart failure: insights from an international cross-sectional study

BACKGROUND

The growing hospital readmission rate among patients with heart failure (HF) has imposed a substantial economic burden on healthcare systems. Therefore, it is essential to identify readmission associating factors to reduce hospital readmission.

AIMS

This study aimed to investigate the relationship of family functioning and family health with hospital readmission rates over six months in patients with HF and identify the sociodemographic and/or clinical variables associated with hospital readmission.

METHODS

This international multicentre cross-sectional study involved a sample of 692 patients with HF from three countries (Denmark 312, Iran 288, and Iceland 92) recruited from January 2015 to May 2020. The Family Functioning, Health, and Social Support questionnaire was used to collect the data. The number of patients' hospital readmissions during the six-month period was retrieved from patients' hospital records.

RESULTS

Of the total sample, 184 (26.6%) patients were readmitted during the six-month period. Of these, 111 (16%) had one readmission, 68 (9.9%) had two readmissions, and 5 (0.7%) had three readmissions. Family functioning, family health, being unemployed, and country of residence were significant factors associated with hospital readmission for the patients.

CONCLUSION

This study highlights the critical roles of family functioning and family health in six-month hospital readmission among patients with HF. Moreover, the strategy of healthcare systems in the management of HF is a key determinant that influences hospital readmission. Our findings may assist the investigation of potential strategies to reduce hospital readmission in patients with HF.

Predictive modeling for COVID-19 readmission risk using machine learning algorithms

Introduction

The COVID-19 pandemic overwhelmed healthcare systems with severe shortages in hospital resources such as ICU beds, specialized doctors, and respiratory ventilators. In this situation, reducing COVID-19 readmissions could potentially maintain hospital capacity. By employing machine learning (ML), we can predict the likelihood of COVID-19 readmission risk, which can assist in the optimal allocation of restricted resources to seriously ill patients.

Methods

In this retrospective single-center study, the data of 1225 COVID-19 patients discharged between January 9, 2020, and October 20, 2021 were analyzed. First, the most important predictors were selected using the horse herd optimization algorithms. Then, three classical ML algorithms, including decision tree, support vector machine, and k-nearest neighbors, and a hybrid algorithm, namely water wave optimization (WWO) as a precise metaheuristic evolutionary algorithm combined with a neural network were used to construct predictive models for COVID-19 readmission. Finally, the performance of prediction models was measured, and the best-performing one was identified.

Results

The ML algorithms were trained using 17 validated features. Among the four selected ML algorithms, the WWO had the best average performance in tenfold cross-validation (accuracy: 0.9705, precision: 0.9729, recall: 0.9869, specificity: 0.9259, F-measure: 0.9795).

Conclusions

Our findings show that the WWO algorithm predicts the risk of readmission of COVID-19 patients more accurately than other ML algorithms. The models developed herein can inform frontline clinicians and healthcare policymakers to manage and optimally allocate limited hospital resources to seriously ill COVID-19 patients.

Predicting hospital readmission risk in patients with COVID-19: A machine learning approach

Introduction

The Coronavirus 2019 (COVID-19) epidemic stunned the health systems with severe scarcities in hospital resources. In this critical situation, decreasing COVID-19 readmissions could potentially sustain hospital capacity. This study aimed to select the most affecting features of COVID-19 readmission and compare the capability of Machine Learning (ML) algorithms to predict COVID-19 readmission based on the selected features.

Material and methods

The data of 5791 hospitalized patients with COVID-19 were retrospectively recruited from a hospital registry system. The LASSO feature selection algorithm was used to select the most important features related to COVID-19 readmission. HistGradientBoosting classifier (HGB), Bagging classifier, Multi-Layered Perceptron (MLP), Support Vector Machine ((SVM) kernel = linear), SVM (kernel = RBF), and Extreme Gradient Boosting (XGBoost) classifiers were used for prediction. We evaluated the performance of ML algorithms with a 10-fold cross-validation method using six performance evaluation metrics.

Results

Out of the 42 features, 14 were identified as the most relevant predictors. The XGBoost classifier outperformed the other six ML models with an average accuracy of 91.7%, specificity of 91.3%, the sensitivity of 91.6%, F-measure of 91.8%, and AUC of 0.91%.

Conclusion

The experimental results prove that ML models can satisfactorily predict COVID-19 readmission. Besides considering the risk factors prioritized in this work, categorizing cases with a high risk of reinfection can make the patient triaging procedure and hospital resource utilization more effective.