Key result
Complex machine learning models reduce inappropriate rhythm-control referrals by ~20% versus simpler models.
Why the study?
Identifying appropriate rhythm management for patients with AF remains challenging, and clinical decision support tools must balance interpretability with accurate prediction.
Do complex machine learning models improve the prediction of rhythm-control strategy in patients diagnosed with atrial fibrillation compared to simpler models?
Case-Control (n=42,022)
Do complex machine learning models improve the prediction of rhythm-control strategy in patients diagnosed with atrial fibrillation compared to simpler models?
Complex machine learning models improve the accuracy of predicting rhythm-control strategies in AF patients, reducing inappropriate referrals by 20%, though at the cost of model interpretability.
May reduce inappropriate AF rhythm-control referrals; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND The identification of an appropriate rhythm management strategy for patients diagnosed with atrial fibrillation (AF) remains a major challenge for providers. Although clinical trials have identified subgroups of patients in whom a rate- or rhythm-control strategy might be indicated to improve outcomes, the wide range of presentations and risk factors among patients presenting with AF makes such approaches challenging. The strength of electronic health records is the ability to build in logic to guide management decisions, such that the system can automatically identify patients in whom a rhythm-control strategy is more likely and can promote efficient referrals to specialists. However, like any clinical decision support tool, there is a balance between interpretability and accurate prediction. OBJECTIVE This study aims to create an electronic health record–based prediction tool to guide patient referral to specialists for rhythm-control management by comparing different machine learning algorithms. METHODS We compared machine learning models of increasing complexity and used up to 50,845 variables to predict the rhythm-control strategy in 42,022 patients within the University of Colorado Health system at the time of AF diagnosis. Models were evaluated on the basis of their classification accuracy, defined by the F1 score and other metrics, and interpretability, captured by inspection of the relative importance of each predictor. RESULTS We found that age was by far the strongest single predictor of a rhythm-control strategy but that greater accuracy could be achieved with more complex models incorporating neural networks and more predictors for each participant. We determined that the impact of better prediction models was notable primarily in the rate of inappropriate referrals for rhythm-control, in which more complex models provided an average of 20% fewer inappropriate referrals than simpler, more interpretable models. CONCLUSIONS We conclude that any health care system seeking to incorporate algorithms to guide rhythm management for patients with AF will need to address this trade-off between prediction accuracy and model interpretability.
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Kim et al. (2021) conducted a case-control in Atrial Fibrillation (n=42,022). Complex machine learning models vs. Simpler machine learning models was evaluated on Prediction of rhythm-control strategy. Complex machine learning models incorporating neural networks reduced inappropriate referrals for rhythm-control by an average of 20% compared to simpler, more interpretable models.
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