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Kolossváry M, Mayrhofer T, Ferencik M, Karády J, Pagidipati NJ, Shah SH, Nanna MG, Foldyna B, Douglas PS, Hoffmann U, Lu MT. Are risk factors necessary for pretest probability assessment of coronary artery disease? A patient similarity network analysis of the PROMISE trial. J Cardiovasc Comput Tomogr 2022; 16:397-403. [PMID: 35393245 PMCID: PMC9452442 DOI: 10.1016/j.jcct.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pretest probability (PTP) calculators utilize epidemiological-level findings to provide patient-level risk assessment of obstructive coronary artery disease (CAD). However, their limited accuracies question whether dissimilarities in risk factors necessarily result in differences in CAD. Using patient similarity network (PSN) analyses, we wished to assess the accuracy of risk factors and imaging markers to identify ≥50% luminal narrowing on coronary CT angiography (CCTA) in stable chest-pain patients. METHODS We created four PSNs representing: patient characteristics, risk factors, non-coronary imaging markers and calcium score. We used spectral clustering to group individuals with similar risk profiles. We compared PSNs to a contemporary PTP score incorporating calcium score and risk factors to identify ≥50% luminal narrowing on CCTA in the CT-arm of the PROMISE trial. We also conducted subanalyses in different age and sex groups. RESULTS In 3556 individuals, the calcium score PSN significantly outperformed patient characteristic, risk factor, and non-coronary imaging marker PSNs (AUC: 0.81 vs. 0.57, 0.55, 0.54; respectively, p < 0.001 for all). The calcium score PSN significantly outperformed the contemporary PTP score (AUC: 0.81 vs. 0.78, p < 0.001), and using 0, 1-100 and > 100 cut-offs provided comparable results (AUC: 0.81 vs. 0.81, p = 0.06). Similar results were found in all subanalyses. CONCLUSION Calcium score on its own provides better individualized obstructive CAD prediction than contemporary PTP scores incorporating calcium score and risk factors. Risk factors may not be able to improve the diagnostic accuracy of calcium score to predict ≥50% luminal narrowing on CCTA.
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Affiliation(s)
- Márton Kolossváry
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Maros Ferencik
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Júlia Karády
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Neha J Pagidipati
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Svati H Shah
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Udo Hoffmann
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Hu Z, Qiu H, Wang L, Shen M. Network analytics and machine learning for predicting length of stay in elderly patients with chronic diseases at point of admission. BMC Med Inform Decis Mak 2022; 22:62. [PMID: 35272654 PMCID: PMC8915508 DOI: 10.1186/s12911-022-01802-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background An aging population with a burden of chronic diseases puts increasing pressure on health care systems. Early prediction of the hospital length of stay (LOS) can be useful in optimizing the allocation of medical resources, and improving healthcare quality. However, the data available at the point of admission (PoA) are limited, making it difficult to forecast the LOS accurately. Methods In this study, we proposed a novel approach combining network analytics and machine learning to predict the LOS in elderly patients with chronic diseases at the PoA. Two networks, including multimorbidity network (MN) and patient similarity network (PSN), were constructed and novel network features were created. Five machine learning models (eXtreme Gradient Boosting, Gradient Boosting Decision Tree, Random Forest, Linear Support Vector Machine, and Deep Neural Network) with different input feature sets were developed to compare their performance. Results The experimental results indicated that the network features can bring significant improvements to the performances of the prediction models, suggesting that the MN and PSN are useful for LOS predictions. Conclusion Our predictive framework which integrates network science with data mining can forecast the LOS effectively at the PoA and provide decision support for hospital managers, which highlights the potential value of network-based machine learning in healthcare field.
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Affiliation(s)
- Zhixu Hu
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave, West Hi-Tech Zone, 611731, Chengdu, Sichuan, People's Republic of China
| | - Hang Qiu
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave, West Hi-Tech Zone, 611731, Chengdu, Sichuan, People's Republic of China. .,Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
| | - Liya Wang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Minghui Shen
- Health Information Center of Sichuan Province, Chengdu, People's Republic of China
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