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Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data
Atrial fibrillation (AF) is the most common arrhythmia and significantly increases stroke risk. This risk is effectively managed by oral anticoagulation. Recent studies using national registry data indicate increased use of anticoagulation resulting from changes in guidelines and the availability of...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876873/ https://www.ncbi.nlm.nih.gov/pubmed/31765395 http://dx.doi.org/10.1371/journal.pone.0225625 |
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author | Bean, Daniel M. Teo, James Wu, Honghan Oliveira, Ricardo Patel, Raj Bendayan, Rebecca Shah, Ajay M. Dobson, Richard J. B. Scott, Paul A. |
author_facet | Bean, Daniel M. Teo, James Wu, Honghan Oliveira, Ricardo Patel, Raj Bendayan, Rebecca Shah, Ajay M. Dobson, Richard J. B. Scott, Paul A. |
author_sort | Bean, Daniel M. |
collection | PubMed |
description | Atrial fibrillation (AF) is the most common arrhythmia and significantly increases stroke risk. This risk is effectively managed by oral anticoagulation. Recent studies using national registry data indicate increased use of anticoagulation resulting from changes in guidelines and the availability of newer drugs. The aim of this study is to develop and validate an open source risk scoring pipeline for free-text electronic health record data using natural language processing. AF patients discharged from 1(st) January 2011 to 1(st) October 2017 were identified from discharge summaries (N = 10,030, 64.6% male, average age 75.3 ± 12.3 years). A natural language processing pipeline was developed to identify risk factors in clinical text and calculate risk for ischaemic stroke (CHA(2)DS(2)-VASc) and bleeding (HAS-BLED). Scores were validated vs two independent experts for 40 patients. Automatic risk scores were in strong agreement with the two independent experts for CHA(2)DS(2)-VASc (average kappa 0.78 vs experts, compared to 0.85 between experts). Agreement was lower for HAS-BLED (average kappa 0.54 vs experts, compared to 0.74 between experts). In high-risk patients (CHA(2)DS(2)-VASc ≥2) OAC use has increased significantly over the last 7 years, driven by the availability of DOACs and the transitioning of patients from AP medication alone to OAC. Factors independently associated with OAC use included components of the CHA(2)DS(2)-VASc and HAS-BLED scores as well as discharging specialty and frailty. OAC use was highest in patients discharged under cardiology (69%). Electronic health record text can be used for automatic calculation of clinical risk scores at scale. Open source tools are available today for this task but require further validation. Analysis of routinely collected EHR data can replicate findings from large-scale curated registries. |
format | Online Article Text |
id | pubmed-6876873 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-68768732019-12-08 Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data Bean, Daniel M. Teo, James Wu, Honghan Oliveira, Ricardo Patel, Raj Bendayan, Rebecca Shah, Ajay M. Dobson, Richard J. B. Scott, Paul A. PLoS One Research Article Atrial fibrillation (AF) is the most common arrhythmia and significantly increases stroke risk. This risk is effectively managed by oral anticoagulation. Recent studies using national registry data indicate increased use of anticoagulation resulting from changes in guidelines and the availability of newer drugs. The aim of this study is to develop and validate an open source risk scoring pipeline for free-text electronic health record data using natural language processing. AF patients discharged from 1(st) January 2011 to 1(st) October 2017 were identified from discharge summaries (N = 10,030, 64.6% male, average age 75.3 ± 12.3 years). A natural language processing pipeline was developed to identify risk factors in clinical text and calculate risk for ischaemic stroke (CHA(2)DS(2)-VASc) and bleeding (HAS-BLED). Scores were validated vs two independent experts for 40 patients. Automatic risk scores were in strong agreement with the two independent experts for CHA(2)DS(2)-VASc (average kappa 0.78 vs experts, compared to 0.85 between experts). Agreement was lower for HAS-BLED (average kappa 0.54 vs experts, compared to 0.74 between experts). In high-risk patients (CHA(2)DS(2)-VASc ≥2) OAC use has increased significantly over the last 7 years, driven by the availability of DOACs and the transitioning of patients from AP medication alone to OAC. Factors independently associated with OAC use included components of the CHA(2)DS(2)-VASc and HAS-BLED scores as well as discharging specialty and frailty. OAC use was highest in patients discharged under cardiology (69%). Electronic health record text can be used for automatic calculation of clinical risk scores at scale. Open source tools are available today for this task but require further validation. Analysis of routinely collected EHR data can replicate findings from large-scale curated registries. Public Library of Science 2019-11-25 /pmc/articles/PMC6876873/ /pubmed/31765395 http://dx.doi.org/10.1371/journal.pone.0225625 Text en © 2019 Bean et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Bean, Daniel M. Teo, James Wu, Honghan Oliveira, Ricardo Patel, Raj Bendayan, Rebecca Shah, Ajay M. Dobson, Richard J. B. Scott, Paul A. Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data |
title | Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data |
title_full | Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data |
title_fullStr | Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data |
title_full_unstemmed | Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data |
title_short | Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data |
title_sort | semantic computational analysis of anticoagulation use in atrial fibrillation from real world data |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876873/ https://www.ncbi.nlm.nih.gov/pubmed/31765395 http://dx.doi.org/10.1371/journal.pone.0225625 |
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