Predicting multifaceted risks using machine learning in atrial fibrillation: insights from GLORIA-AF study
European Heart Journal - Digital Health, vol. 5, pp. 235–246
Abstract
Abstract Aims Patients with atrial fibrillation (AF) have a higher risk of ischaemic stroke and death. While anticoagulants are effective at reducing these risks, they increase the risk of bleeding. Current clinical risk scores only perform modestly in predicting adverse outcomes, especially for the outcome of death. We aimed to test the multi-label gradient boosting decision tree (ML-GBDT) model in predicting risks for adverse outcomes in a prospective global AF registry. Methods and results We studied patients from phase II/III of the Global Registry on Long-Term Oral Anti-Thrombotic Treatment in Patients with Atrial Fibrillation registry between 2011 and 2020. The outcomes were all-cause death, ischaemic stroke, and major bleeding within 1 year following the AF. We trained the ML-GBDT model and compared its discrimination with the clinical scores in predicting patient outcomes. A total of 25 656 patients were included [mean age 70.3 years (SD 10.3); 44.8% female]. Within 1 year after AF, ischaemic stroke occurred in 215 (0.8%), major bleeding in 405 (1.6%), and death in 897 (3.5%) patients. Our model achieved an optimized area under the curve in predicting death (0.785, 95% CI: 0.757–0.813) compared with the Charlson Comorbidity Index (0.747, P = 0.007), ischaemic stroke (0.691, 0.626–0.756) compared with CHA2DS2-VASc (0.613, P = 0.028), and major bleeding (0.698, 0.651–0.745) as opposed to HAS-BLED (0.607, P = 0.002), with improvement in net reclassification index (10.0, 12.5, and 23.6%, respectively). Conclusion The ML-GBDT model outperformed clinical risk scores in predicting the risks in patients with AF. This approach could be used as a single multifaceted holistic tool to optimize patient risk assessment and mitigate adverse outcomes when managing AF.
Authors 13
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University of Liverpool · The University of Western Australia · Harry Perkins Institute of Medical Research · Liverpool Heart and Chest Hospital · Liverpool John Moores University
Affiliation as printed
Department of Computer Science and Software Engineering, The University of Western Australia , 35 Stirling Hwy, Crawley WA 6009 , Australia
Harry Perkins Institute of Medical Research , 5 Robin Warren Dr, Murdoch WA 6150 , Australia
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Thomas Drive, Liverpool L14 3PE , UK
Medical School, The University of Western Australia , 35 Stirling Hwy, Crawley WA 6009 , Australia
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Université de Tours · University of Liverpool · Liverpool Heart and Chest Hospital · Centre Hospitalier Universitaire de Tours · Liverpool John Moores University
Affiliation as printed
Department of Cardiology, University Hospital and University of Tours , Tours , France
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Thomas Drive, Liverpool L14 3PE , UK
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Harry Perkins Institute of Medical Research
Affiliation as printed
Harry Perkins Institute of Medical Research , 5 Robin Warren Dr, Murdoch WA 6150 , Australia
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University of Liverpool · Liverpool Heart and Chest Hospital · Liverpool John Moores University
Affiliation as printed
Department of Eye and Vision Sciences, University of Liverpool , Liverpool , UK
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Thomas Drive, Liverpool L14 3PE , UK
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The University of Western Australia
Affiliation as printed
School of Population and Global Health, The University of Western Australia , Perth , Australia
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The University of Western Australia
Affiliation as printed
Medical School, The University of Western Australia , 35 Stirling Hwy, Crawley WA 6009 , Australia
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The University of Western Australia
Affiliation as printed
School of Population and Global Health, The University of Western Australia , Perth , Australia
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The University of Western Australia · Sir Charles Gairdner Hospital
Affiliation as printed
Medical School, The University of Western Australia , 35 Stirling Hwy, Crawley WA 6009 , Australia
Sir Charles Gairdner Hospital , Perth , Australia
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The University of Western Australia
Affiliation as printed
Medical School, The University of Western Australia , 35 Stirling Hwy, Crawley WA 6009 , Australia
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The University of Sydney · Royal North Shore Hospital
Affiliation as printed
Department of Cardiology, Royal North Shore Hospital , Sydney , Australia
Kolling Institute and Charles Perkins Centre, University of Sydney , Sydney , Australia
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Menno Volkert Huisman Aachen Department of Thrombosis and Hemostasis Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Thrombosis and Hemostasis Leiden University Medical Center , Leiden , The Netherlands
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Girish Dwivedi corresponding
The University of Western Australia · Harry Perkins Institute of Medical Research · Fiona Stanley Hospital
Affiliation as printed
Department of Cardiology, Fiona Stanley Hospital , Perth , Australia
Harry Perkins Institute of Medical Research , 5 Robin Warren Dr, Murdoch WA 6150 , Australia
Medical School, The University of Western Australia , 35 Stirling Hwy, Crawley WA 6009 , Australia
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Gregory Y.H. Lip corresponding
University of Liverpool · Liverpool Heart and Chest Hospital · Liverpool John Moores University · Aalborg University
Affiliation as printed
Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University , Selma Lagerløfs Vej 249, 9260 Gistrup , Denmark
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Thomas Drive, Liverpool L14 3PE , UK
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