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Predicting in-hospital mortality after transcatheter aortic valve replacement using administrative data and machine learning

Alhwiti, Theyab
Aldrugh, Summer
Megahed, Fadel M
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UMass Chan Affiliations
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Journal Article
Publication Date
2023-06-24
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Abstract

Transcatheter aortic valve replacement (TAVR) is the gold standard treatment for patients with symptomatic aortic stenosis. The utility of existing risk prediction tools for in-hospital mortality post-TAVR is limited due to two major factors: (a) the predictive accuracy of these tools is insufficient when only preoperative variables are incorporated, and (b) their efficacy is also compromised when solely postoperative variables are employed, subsequently constraining their application in preoperative decision support. This study examined whether statistical/machine learning models trained with solely preoperative information encoded in the administrative National Inpatient Sample database could accurately predict in-hospital outcomes (death/survival) post-TAVR. Fifteen popular binary classification methods were used to model in-hospital survival/death. These methods were evaluated using multiple classification metrics, including the area under the receiver operating characteristic curve (AUC). By analyzing 54,739 TAVRs, the top five classification models had an AUC ≥ 0.80 for two sampling scenarios: random, consistent with previous studies, and time-based, which assessed whether the models could be deployed without frequent retraining. Given the minimal practical differences in the predictive accuracies of the top five models, the L2 regularized logistic regression model is recommended as the best overall model since it is computationally efficient and easy to interpret.

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Alhwiti T, Aldrugh S, Megahed FM. Predicting in-hospital mortality after transcatheter aortic valve replacement using administrative data and machine learning. Sci Rep. 2023 Jun 24;13(1):10252. doi: 10.1038/s41598-023-37358-9. PMID: 37355688; PMCID: PMC10290690.

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DOI
10.1038/s41598-023-37358-9
PubMed ID
37355688
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Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creativecommons. org/ licenses/ by/4. 0/. © The Author(s) 2023