Enhancing heart failure treatment decisions: interpretable machine learning models for advanced therapy eligibility prediction using EHR data

Abstract

Timely and accurate referral of end-stage heart failure patients for advanced therapies, including heart transplants and mechanical circulatory support, plays an important role in improving patient outcomes and saving costs. However, the decision-making process is complex, nuanced, and time-consuming, requiring cardiologists with specialized expertise and training in heart failure and transplantation. In this study, we propose two logistic tensor regression-based models to predict patients with heart failure warranting evaluation for advanced heart failure therapies using irregularly spaced sequential electronic health records at the population and individual levels. The clinical features were collected at the previous visit and the predictions were made at the very beginning of the subsequent visit. Patient-wise ten-fold cross-validation experiments were performed. Standard LTR achieved an average F1 score of 0.708, AUC of 0.903, and AUPRC of 0.836. Personalized LTR obtained an F1 score of 0.670, an AUC of 0.869 and an AUPRC of 0.839. The two models not only outperformed all other machine learning models to which they were compared but also improved the performance and robustness of the other models via weight transfer. The AUPRC scores of support vector machine, random forest, and Naive Bayes are improved by 8.87%, 7.24%, and 11.38%, respectively. The two models can evaluate the importance of clinical features associated with advanced therapy referral. The five most important medical codes, including chronic kidney disease, hypotension, pulmonary heart disease, mitral regurgitation, and atherosclerotic heart disease, were reviewed and validated with literature and by heart failure cardiologists. Our proposed models effectively utilize EHRs for potential advanced therapies necessity in heart failure patients while explaining the importance of comorbidities and other clinical events. The information learned from trained model training could offer further insight into risk factors contributing to the progression of heart failure at both the population and individual levels.