Prediction of incident myocardial infarction using machine learning applied to harmonized electronic health record data

• Published in: BMC medical informatics and decision making 2020-10, Vol.20 (1), p.252-252, Article 252
• Main Authors: Mandair, Divneet, Tiwari, Premanand, Simon, Steven, Colborn, Kathryn L, Rosenberg, Michael A
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Algorithms; Analysis; Artificial neural networks; Calibration; Cardiac patients; Cardiovascular diseases; Case-Control Studies; Classification; Data models; Datasets; Deep learning; Electronic health records; Electronic Health Records - statistics & numerical data; Electronic medical records; Electronic records; Female; Health informatics; Heart attack; Heart attacks; Humans; Incidence; Learning algorithms; Logistics; Machine Learning; Medical records; Medical research; Mortality; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Neural networks; Parameter identification; Patients; Predictive Value of Tests; Prognosis; Regression analysis; Regression models; Risk analysis; Risk factors
• ISSN: 1472-6947; 1472-6947
• DOI: 10.1186/s12911-020-01268-x

With cardiovascular disease increasing, substantial research has focused on the development of prediction tools. We compare deep learning and machine learning models to a baseline logistic regression using only 'known' risk factors in predicting incident myocardial infarction (MI) from harmonized EHR data. Large-scale case-control study with outcome of 6-month incident MI, conducted using the top 800, from an initial 52 k procedures, diagnoses, and medications within the UCHealth system, harmonized to the Observational Medical Outcomes Partnership common data model, performed on 2.27 million patients. We compared several over- and under- sampling techniques to address the imbalance in the dataset. We compared regularized logistics regression, random forest, boosted gradient machines, and shallow and deep neural networks. A baseline model for comparison was a logistic regression using a limited set of 'known' risk factors for MI. Hyper-parameters were identified using 10-fold cross-validation. Twenty thousand Five hundred and ninety-one patients were diagnosed with MI compared with 2.25 million who did not. A deep neural network with random undersampling provided superior classification compared with other methods. However, the benefit of the deep neural network was only moderate, showing an F1 Score of 0.092 and AUC of 0.835, compared to a logistic regression model using only 'known' risk factors. Calibration for all models was poor despite adequate discrimination, due to overfitting from low frequency of the event of interest. Our study suggests that DNN may not offer substantial benefit when trained on harmonized data, compared to traditional methods using established risk factors for MI.