Towards artificial intelligence-based learning health system for population-level mortality prediction using electrocardiograms

Weijie Sun and Sunil Vasu Kalmady and Nariman Sepehrvand and Amir Salimi and Yousef Nademi and Kevin Bainey and Justin A. Ezekowitz and Russell Greiner and Abram Hindle and Finlay A. McAlister and Roopinder K. Sandhu and Padma Kaul

2023/01/01

Towards artificial intelligence-based learning health system for population-level mortality prediction using electrocardiograms

Authors

Weijie Sun and Sunil Vasu Kalmady and Nariman Sepehrvand and Amir Salimi and Yousef Nademi and Kevin Bainey and Justin A. Ezekowitz and Russell Greiner and Abram Hindle and Finlay A. McAlister and Roopinder K. Sandhu and Padma Kaul

Venue

Abstract

The feasibility and value of linking electrocardiogram (ECG) data to longitudinal population-level administrative health data to facilitate the development of a learning healthcare system has not been fully explored. We developed ECG-based machine learning models to predict risk of mortality among patients presenting to an emergency department or hospital for any reason. Using the 12-lead ECG traces and measurements from 1,605,268 ECGs from 748,773 healthcare episodes of 244,077 patients (2007–2020) in Alberta, Canada, we developed and validated ResNet-based Deep Learning (DL) and gradient boosting-based XGBoost (XGB) models to predict 30-day, 1-year, and 5-year mortality. The models for 30-day, 1-year, and 5-year mortality were trained on 146,173, 141,072, and 111,020 patients and evaluated on 97,144, 89,379, and 55,650 patients, respectively. In the evaluation cohort, 7.6%, 17.3%, and 32.9% patients died by 30-days, 1-year, and 5-years, respectively. ResNet models based on ECG traces alone had good-to-excellent performance with area under receiver operating characteristic curve (AUROC) of 0.843 (95% CI: 0.838–0.848), 0.812 (0.808–0.816), and 0.798 (0.792–0.803) for 30-day, 1-year and 5-year prediction, respectively; and were superior to XGB models based on ECG measurements with AUROC of 0.782 (0.776–0.789), 0.784 (0.780–0.788), and 0.746 (0.740–0.751). This study demonstrates the validity of ECG-based DL mortality prediction models at the population-level that can be leveraged for prognostication at point of care.

Bibtex

@article{sun2023npjdigitalmedicine-pop-ecg,
 abstract = {The feasibility and value of linking electrocardiogram (ECG) data to longitudinal population-level administrative health data to facilitate the development of a learning healthcare system has not been fully explored. We developed ECG-based machine learning models to predict risk of mortality among patients presenting to an emergency department or hospital for any reason. Using the 12-lead ECG traces and measurements from 1,605,268 ECGs from 748,773 healthcare episodes of 244,077 patients (2007–2020) in Alberta, Canada, we developed and validated ResNet-based Deep Learning (DL) and gradient boosting-based XGBoost (XGB) models to predict 30-day, 1-year, and 5-year mortality. The models for 30-day, 1-year, and 5-year mortality were trained on 146,173, 141,072, and 111,020 patients and evaluated on 97,144, 89,379, and 55,650 patients, respectively. In the evaluation cohort, 7.6%, 17.3%, and 32.9% patients died by 30-days, 1-year, and 5-years, respectively. ResNet models based on ECG traces alone had good-to-excellent performance with area under receiver operating characteristic curve (AUROC) of 0.843 (95% CI: 0.838–0.848), 0.812 (0.808–0.816), and 0.798 (0.792–0.803) for 30-day, 1-year and 5-year prediction, respectively; and were superior to XGB models based on ECG measurements with AUROC of 0.782 (0.776–0.789), 0.784 (0.780–0.788), and 0.746 (0.740–0.751). This study demonstrates the validity of ECG-based DL mortality prediction models at the population-level that can be leveraged for prognostication at point of care.},
 author = {Weijie Sun and Sunil Vasu Kalmady and Nariman Sepehrvand and Amir Salimi and Yousef Nademi and Kevin Bainey and Justin A. Ezekowitz and Russell Greiner and Abram Hindle and Finlay A. McAlister and Roopinder K. Sandhu and Padma Kaul},
 authors = {Weijie Sun and Sunil Vasu Kalmady and Nariman Sepehrvand and Amir Salimi and Yousef Nademi and Kevin Bainey and Justin A. Ezekowitz and Russell Greiner and Abram Hindle and Finlay A. McAlister and Roopinder K. Sandhu and Padma Kaul},
 code = {sun2023npjdigitalmedicine-pop-ecg},
 day = {06},
 doi = {https://doi.org/10.1038/s41746-023-00765-3},
 funding = {NSERC Discovery, CIHR},
 institution = {University of Alberta},
 journal = {npj Digital Medicine},
 month = {February},
 number = {1},
 pages = {1--12},
 role = { Researcher / Co-author},
 title = {Towards artificial intelligence-based learning health system for population-level mortality prediction using electrocardiograms},
 type = {article},
 url = {http://softwareprocess.ca/pubs/sun2023npjdigitalmedicine-pop-ecg.pdf},
 venue = {npj Digital Medicine},
 volume = {6},
 year = {2023}
}