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AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study

BACKGROUND: Overcrowding of hospitals and emergency departments (EDs) is a growing problem. However, not all ED consultations are necessary. For example, 80% of patients in the ED with chest pain do not have an acute coronary syndrome (ACS). Artificial intelligence (AI) is useful in analyzing (medic...

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Autores principales: de Koning, Enrico, van der Haas, Yvette, Saguna, Saguna, Stoop, Esmee, Bosch, Jan, Beeres, Saskia, Schalij, Martin, Boogers, Mark
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10646678/
https://www.ncbi.nlm.nih.gov/pubmed/37906226
http://dx.doi.org/10.2196/51375
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author de Koning, Enrico
van der Haas, Yvette
Saguna, Saguna
Stoop, Esmee
Bosch, Jan
Beeres, Saskia
Schalij, Martin
Boogers, Mark
author_facet de Koning, Enrico
van der Haas, Yvette
Saguna, Saguna
Stoop, Esmee
Bosch, Jan
Beeres, Saskia
Schalij, Martin
Boogers, Mark
author_sort de Koning, Enrico
collection PubMed
description BACKGROUND: Overcrowding of hospitals and emergency departments (EDs) is a growing problem. However, not all ED consultations are necessary. For example, 80% of patients in the ED with chest pain do not have an acute coronary syndrome (ACS). Artificial intelligence (AI) is useful in analyzing (medical) data, and might aid health care workers in prehospital clinical decision-making before patients are presented to the hospital. OBJECTIVE: The aim of this study was to develop an AI model which would be able to predict ACS before patients visit the ED. The model retrospectively analyzed prehospital data acquired by emergency medical services' nurse paramedics. METHODS: Patients presenting to the emergency medical services with symptoms suggestive of ACS between September 2018 and September 2020 were included. An AI model using a supervised text classification algorithm was developed to analyze data. Data were analyzed for all 7458 patients (mean 68, SD 15 years, 54% men). Specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for control and intervention groups. At first, a machine learning (ML) algorithm (or model) was chosen; afterward, the features needed were selected and then the model was tested and improved using iterative evaluation and in a further step through hyperparameter tuning. Finally, a method was selected to explain the final AI model. RESULTS: The AI model had a specificity of 11% and a sensitivity of 99.5% whereas usual care had a specificity of 1% and a sensitivity of 99.5%. The PPV of the AI model was 15% and the NPV was 99%. The PPV of usual care was 13% and the NPV was 94%. CONCLUSIONS: The AI model was able to predict ACS based on retrospective data from the prehospital setting. It led to an increase in specificity (from 1% to 11%) and NPV (from 94% to 99%) when compared to usual care, with a similar sensitivity. Due to the retrospective nature of this study and the singular focus on ACS it should be seen as a proof-of-concept. Other (possibly life-threatening) diagnoses were not analyzed. Future prospective validation is necessary before implementation.
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spelling pubmed-106466782023-10-31 AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study de Koning, Enrico van der Haas, Yvette Saguna, Saguna Stoop, Esmee Bosch, Jan Beeres, Saskia Schalij, Martin Boogers, Mark JMIR Cardio Original Paper BACKGROUND: Overcrowding of hospitals and emergency departments (EDs) is a growing problem. However, not all ED consultations are necessary. For example, 80% of patients in the ED with chest pain do not have an acute coronary syndrome (ACS). Artificial intelligence (AI) is useful in analyzing (medical) data, and might aid health care workers in prehospital clinical decision-making before patients are presented to the hospital. OBJECTIVE: The aim of this study was to develop an AI model which would be able to predict ACS before patients visit the ED. The model retrospectively analyzed prehospital data acquired by emergency medical services' nurse paramedics. METHODS: Patients presenting to the emergency medical services with symptoms suggestive of ACS between September 2018 and September 2020 were included. An AI model using a supervised text classification algorithm was developed to analyze data. Data were analyzed for all 7458 patients (mean 68, SD 15 years, 54% men). Specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for control and intervention groups. At first, a machine learning (ML) algorithm (or model) was chosen; afterward, the features needed were selected and then the model was tested and improved using iterative evaluation and in a further step through hyperparameter tuning. Finally, a method was selected to explain the final AI model. RESULTS: The AI model had a specificity of 11% and a sensitivity of 99.5% whereas usual care had a specificity of 1% and a sensitivity of 99.5%. The PPV of the AI model was 15% and the NPV was 99%. The PPV of usual care was 13% and the NPV was 94%. CONCLUSIONS: The AI model was able to predict ACS based on retrospective data from the prehospital setting. It led to an increase in specificity (from 1% to 11%) and NPV (from 94% to 99%) when compared to usual care, with a similar sensitivity. Due to the retrospective nature of this study and the singular focus on ACS it should be seen as a proof-of-concept. Other (possibly life-threatening) diagnoses were not analyzed. Future prospective validation is necessary before implementation. JMIR Publications 2023-10-31 /pmc/articles/PMC10646678/ /pubmed/37906226 http://dx.doi.org/10.2196/51375 Text en ©Enrico de Koning, Yvette van der Haas, Saguna Saguna, Esmee Stoop, Jan Bosch, Saskia Beeres, Martin Schalij, Mark Boogers. Originally published in JMIR Cardio (https://cardio.jmir.org), 31.10.2023. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Cardio, is properly cited. The complete bibliographic information, a link to the original publication on https://cardio.jmir.org, as well as this copyright and license information must be included.
spellingShingle Original Paper
de Koning, Enrico
van der Haas, Yvette
Saguna, Saguna
Stoop, Esmee
Bosch, Jan
Beeres, Saskia
Schalij, Martin
Boogers, Mark
AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study
title AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study
title_full AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study
title_fullStr AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study
title_full_unstemmed AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study
title_short AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study
title_sort ai algorithm to predict acute coronary syndrome in prehospital cardiac care: retrospective cohort study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10646678/
https://www.ncbi.nlm.nih.gov/pubmed/37906226
http://dx.doi.org/10.2196/51375
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