Learning dynamic treatment strategies for coronary heart diseases by artificial intelligence: real-world data-driven study.
Background: Coronary heart disease (CHD) has become the leading cause of death and one of the most serious epidemic diseases worldwide. CHD is characterized by urgency, danger and severity, and dynamic treatment strategies for CHD patients are needed. We aimed to build and validate an AI model for d...
| Publicado en: | BMC Medical Informatics & Decision Making Vol. 22; no. 1; pp. 1 - 17 |
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| Autores principales: | , , , |
| Formato: | research Journal Article |
| Publicado: |
BioMed Central
2/15/2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=155261094&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 155261094 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14726947 1CI0 jtl: BMC Medical Informatics & Decision Making issn: 14726947 maglogo: N pubinfo: dt: 2/15/2022 vid: 22 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 155261094 155261094 NLM35168623 155261094 10.1186/s12911-022-01774-0 NLM35168623 155261094 ppf: 1 ppct: 16 formats: tig: atl: Learning dynamic treatment strategies for coronary heart diseases by artificial intelligence: real-world data-driven study. aug: au: Guo, Haihong Li, Jiao Liu, Hongyan He, Jun affil: School of Information, Renmin University of China, 59 Zhongguancun Street, Haidian District, 100872, Beijing, China sug: subj: Coronary Disease Therapy Decision Support Systems, Clinical Artificial Intelligence Algorithms Human Intensive Care Units Comparative Studies Multicenter Studies Evaluation Research Validation Studies Scales ab: Background: Coronary heart disease (CHD) has become the leading cause of death and one of the most serious epidemic diseases worldwide. CHD is characterized by urgency, danger and severity, and dynamic treatment strategies for CHD patients are needed. We aimed to build and validate an AI model for dynamic treatment recommendations for CHD patients with the goal of improving patient outcomes and learning best practices from clinicians to help clinical decision support for treating CHD patients.Methods: We formed the treatment strategy as a sequential decision problem, and applied an AI supervised reinforcement learning-long short-term memory (SRL-LSTM) framework that combined supervised learning (SL) and reinforcement learning (RL) with an LSTM network to track patients' states to learn a recommendation model that took a patient's diagnosis and evolving health status as input and provided a treatment recommendation in the form of whether to take specific drugs. The experiments were conducted by leveraging a real-world intensive care unit (ICU) database with 13,762 admitted patients diagnosed with CHD. We compared the performance of the applied SRL-LSTM model and several state-of-the-art SL and RL models in reducing the estimated in-hospital mortality and the Jaccard similarity with clinicians' decisions. We used a random forest algorithm to calculate the feature importance of both the clinician policy and the AI policy to illustrate the interpretability of the AI model.Results: Our experimental study demonstrated that the AI model could help reduce the estimated in-hospital mortality through its RL function and learn the best practice from clinicians through its SL function. The similarity between the clinician policy and the AI policy regarding the surviving patients was high, while for the expired patients, it was much lower. The dynamic treatment strategies made by the AI model were clinically interpretable and relied on sensible clinical features extracted according to monitoring indexes and risk factors for CHD patients.Conclusions: We proposed a pipeline for constructing an AI model to learn dynamic treatment strategies for CHD patients that could improve patient outcomes and mimic the best practices of clinicians. And a lot of further studies and efforts are needed to make it practical. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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