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Machine Learning Outperforms ACC / AHA CVD Risk Calculator in MESA.
Background Studies have demonstrated that the current US guidelines based on American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations Risk Calculator may underestimate risk of atherosclerotic cardiovascular disease ( CVD ) in certain high-risk individuals, therefore missing opportunities for intensive therapy and preventing CVD events. Similarly, the guidelines may overestimate risk in low risk populations resulting in unnecessary statin therapy. We used Machine Learning ( ML ) to tackle this problem. Methods and Results We developed a ML Risk Calculator based on Support Vector Machines ( SVM s) using a 13-year follow up data set from MESA (the Multi-Ethnic Study of Atherosclerosis) of 6459 participants who were atherosclerotic CVD-free at baseline. We provided identical input to both risk calculators and compared their performance. We then used the FLEMENGHO study (the Flemish Study of Environment, Genes and Health Outcomes) to validate the model in an external cohort. ACC / AHA Risk Calculator, based on 7.5% 10-year risk threshold, recommended statin to 46.0%. Despite this high proportion, 23.8% of the 480 "Hard CVD " events occurred in those not recommended statin, resulting in sensitivity 0.76, specificity 0.56, and AUC 0.71. In contrast, ML Risk Calculator recommended only 11.4% to take statin, and only 14.4% of "Hard CVD " events occurred in those not recommended statin, resulting in sensitivity 0.86, specificity 0.95, and AUC 0.92. Similar results were found for prediction of "All CVD " events. Conclusions The ML Risk Calculator outperformed the ACC/AHA Risk Calculator by recommending less drug therapy, yet missing fewer events. Additional studies are underway to validate the ML model in other cohorts and to explore its ability in short-term CVD risk prediction
Development of a bed-based nighttime monitoring toolset
Doctor of PhilosophyDepartment of Electrical and Computer EngineeringSteven WarrenA movement is occurring within the healthcare field towards evidence-based or preventative care-based medicine, which requires personalized monitoring solutions. For medical technologies to fit within this framework, they need to adapt. Reduced cost of operation, ease-of-use, durability, and acceptance will be critical design considerations that will determine their success. Wearable technologies have shown the capability to monitor physiological signals at a reduced cost, but they require consistent effort from the user. Innovative unobtrusive and autonomous monitoring technologies will be needed to make personalized healthcare a reality.
Ballistocardiography, a nearly forgotten field, has reemerged as a promising alternative for unobtrusive physiological monitoring. Heart rate, heart rate variability, respiration rate, movement, and additional hemodynamic features can be estimated from the ballistocardiogram (BCG). This dissertation presents a bed-based nighttime monitoring toolset designed to monitor BCG, respiration, and movement data motivated by the need to quantify the sleep of children with severe disabilities and autism – a capability currently unmet by commercial systems.
A review of ballistocardiography instrumentation techniques (Chapter 2) is presented to 1) build an understanding of how the forces generated by the heart are coupled to the measurement apparatus and 2) provide a background of the field. The choice of sensing modalities and acquisition hardware and software for developing the unobtrusive bed-based nighttime monitoring platform is outlined in Chapters 3 and 4. Preliminary results illustrating the system’s ability to track physiological signals are presented in Chapter 5. Analyses were conducted on overnight data acquired from three lower-functioning children with autism (Chapters 6 and 9) who reside at Heartspring, Wichita, KS, where results justified the platform’s multi-sensor architecture and demonstrated the system’s ability to track physiological signals from this sensitive population over many months. Further, this dissertation presents novel BCG signal processing techniques – a signal quality index (Chapter 7) and a preprocessing inverse filter (Chapter 8) that are applicable to any ballistocardiograph. The bed-based nighttime monitoring toolset outlined in this dissertation presents an unobtrusive, autonomous, robust physiological monitoring system that could be used in hospital-based or personalized, home-based medical applications that consist of short or long-term monitoring scenarios