Early detection of heart failure using in-patient longitudinal electronic health records

Heart Failure (HF) is common, with worldwide prevalence of 1%-3% and a lifetime risk of 20% for individuals 40 years or older. Despite its considerable health economic burden, techniques for early detection of HF in the general population are sparse. In this work we tested the hypothesis that a simple Transformer neural network, trained on comprehensive collection of secondary care data across the general population, can be used to prospectively (three-year predictive window) identify patients at an increased risk of first hospitalisation due to HF (HHF). The model was trained using routinely-collected, secondary care health data, including patient demographics, A&E attendances, hospitalisations, outpatient data, medications, blood tests, and vital sign measurements obtained across five years of longitudinal electronic health records (EHRs). The training cohort consisted of n = 183,894 individuals (n = 161,658 age/sex-matched controls and n = 22,236 of first hospitalisation due to HF after a three-year predictive window). Model performance was validated in an independent testing set of n = 8,977 patients (n = 945 HHF patients). Testing set probabilities were well-calibrated and achieved good discriminatory power with Area Under Receiver Operating Characteristic Curve (AUROC]) of 0.86, sensitivity of 36.4% (95% CI: 33.33%-39.56%), specificity of 98.26% (95% CI: 97.95%-98.53%), and PPV of 69.88% (95% CI: 65.86%-73.62%). At Probability of HHF ≥ 90% the model achieved 100% PPV (95% CI: 96.73%-100%) and sensitivity of 11.7% (95% CI: 9.72%-13.91%). Performance was not affected by patient sex or socioeconomic deprivation deciles. Performance was significantly better in Asian, Black, and Mixed ethnicities (AUROC 0.932-0.945) and in the 79-86 age group (AUROC 0.889). We present the first evidence that routinely collected secondary care health record data can be used in the general population to stratify patients at risk of first HHF.