New approaches for predicting outcomes in patients with atrial fibrillation

Aim: we aimed to assess the capabilities of “machine learning” methods in predicting remote outcomes in patients with non-valvular atrial fi brillation (AF).

Methods. From 2015 to 2016 234 patients with non-valvular AF were included in the study (median age 72 (65; 79) years; 50.0% men). During the median follow-up of 2.9 (2.7; 3.2) years 42 patients died, 9 patients had non-fatal acute cerebral circulatory disorders and 3 patients had non-fatal myocardial infarction (MI). These events in 52 subjects (22.2% from all patients included) were combined into a combined endpoint (death and a nonfatal cardiovascular accident at the stage of remote observation). The first 184 patients comprised a “training” group. The next 50 patients formed the “test” group. The following methods of «machine learning» were used in the analysis: classifi cation trees, linear discriminant analysis, the k-nearest neighbor method, support vectors method, neural network.

Results. Long-term outcomes were influenced by age, known traditional risk factors for cardiovascular diseases, the presence of these diseases, changes in intracardiac hemodynamics and heart chambers as evaluated by echocardiography, the presence of concomitant anemia, advanced stages of chronic kidney disease, and the administration of drugs associated with a more severe cardiovascular disease progression (amiodarone, digoxin). The best prognosis was created using the model of linear discriminant analysis, the complex neural network model, and the support vector machine.

Conclusion. Modern methods aimed at prognosis estimation seem to be of importance in cardiology. These methods include big data analysis and machine learning technologies. The methods require further evaluation and confirmation, and in the future they may allow correcting cardiovascular risks, using data from real clinical practice and evidence-based medicine at the same time.