Predicting 90 day acute heart failure readmission and death using machine learning-supported decision analysis

Readmission or death soon after heart failure (HF) admission is a significant problem. Traditional analyses for predicting such events often fail to consider the gamut of characteristics that may contribute- tending to focus on 30-day outcomes even though the window of increased vulnerability may last up to 90 days. Risk assessments incorporating machine learning (ML) methods may be better suited than traditional statistical analyses alone to sort through multitude of data in the electronic health record (EHR) and identify patients at higher risk. HYPOTHESIS: ML-based decision analysis may better identify patients at increased risk for 90-day acute HF readmission or death after incident HF admission. METHODS AND RESULTS: Among 3189 patients who underwent index HF hospitalization, 15.2% experienced primary or acute HF readmission and 11.5% died within 90 days. For risk assessment models, 98 variables were considered across nine data categories. ML techniques were used to help select variables for a final logistic regression (LR) model. The final model's AUC was 0.760 (95% CI 0.752 to 0.767), with sensitivity of 83%. This proved superior to an LR model alone [AUC 0.744 (95% CI 0.732 to 0.755)]. Eighteen variables were identified as risk factors including dilated inferior vena cava, elevated blood pressure, elevated BUN, reduced albumin, abnormal sodium or bicarbonate, and NT pro-BNP elevation. A risk prediction ML-based model developed from comprehensive characteristics within the EHR can efficiently identify patients at elevated risk of 90-day acute HF readmission or death for whom closer follow-up or further interventions may be considered.