■大多数院外心脏骤停(OHCA)发生在普通人群中的个体中,对他们来说,没有既定的风险识别策略。在这项研究中,我们评估使用电子健康记录(EHR)数据来识别普通人群中的OHCA,并确定导致OHCA风险的显著因素.
■分析队列包括2366名OHCA患者和23660名年龄和性别匹配的对照者,他们在华盛顿大学接受医疗保健。合并症,心电图测量,生命体征,从EHR中提取药物处方。主要结果是OHCA。次要结果包括可电击和不可电击OHCA。评估模型性能,包括受试者工作特征曲线下面积和阳性预测值,并根据整个卫生系统的OHCA观察率进行调整。
■人口统计学特征存在显著差异,生命体征,心电图测量,合并症,以及OHCA患者和对照组之间的药物分配。在外部验证中,机器学习模型中的辨别(受试者工作特征曲线下面积0.80~0.85)优于具有常规心血管危险因素的基线模型(受试者工作特征曲线下面积0.66).在99%的特异性阈值下,校正整个卫生系统的基线OHCA发病率,机器学习模型的阳性预测值为2.5%~3.1%,而基线模型的阳性预测值为0.8%.更长的校正QT间隔,药物滥用障碍,液体和电解质紊乱,酗酒,在所有机器学习模型中,较高的心率被确定为OHCA风险的显著预测因子。已确定的心血管危险因素保留了对可电击OHCA的预测重要性,而是人口特征(少数民族,单身婚姻状况)和非心血管合并症(药物滥用障碍)也有助于风险预测。对于不可电击的OHCA,一系列显著的预测因子,包括合并症,习惯,生命体征,人口特征,和心电图测量,已确定。
■在一项基于人群的病例对照研究中,结合了现有EHR数据的机器学习模型显示,OHCA在普通人群中具有合理的区分度和风险富集.在心血管和非心血管领域,与OCHA风险相关的显著因素是无数的。公共卫生和OHCA预测和预防的量身定制战略将需要纳入这种复杂性。
UNASSIGNED: The majority of out-of-hospital cardiac arrests (OHCAs) occur among individuals in the general population, for whom there is no established strategy to identify risk. In this study, we assess the use of electronic health record (EHR) data to identify OHCA in the general population and define salient factors contributing to OHCA risk.
UNASSIGNED: The analytical cohort included 2366 individuals with OHCA and 23 660 age- and sex-matched controls receiving health care at the University of Washington. Comorbidities, electrocardiographic measures, vital signs, and medication prescription were abstracted from the EHR. The primary outcome was OHCA. Secondary outcomes included shockable and nonshockable OHCA. Model performance including area under the receiver operating characteristic curve and positive predictive value were assessed and adjusted for observed rate of OHCA across the health system.
UNASSIGNED: There were significant differences in demographic characteristics, vital signs, electrocardiographic measures, comorbidities, and medication distribution between individuals with OHCA and controls. In external validation, discrimination in machine learning models (area under the receiver operating characteristic curve 0.80-0.85) was superior to a baseline model with conventional cardiovascular risk factors (area under the receiver operating characteristic curve 0.66). At a specificity threshold of 99%, correcting for baseline OHCA incidence across the health system, positive predictive value was 2.5% to 3.1% in machine learning models compared with 0.8% for the baseline model. Longer corrected QT interval, substance abuse disorder, fluid and electrolyte disorder, alcohol abuse, and higher heart rate were identified as salient predictors of OHCA risk across all machine learning models. Established cardiovascular risk factors retained predictive importance for shockable OHCA, but demographic characteristics (minority race, single marital status) and noncardiovascular comorbidities (substance abuse disorder) also contributed to risk prediction. For nonshockable OHCA, a range of salient predictors, including comorbidities, habits, vital signs, demographic characteristics, and electrocardiographic measures, were identified.
UNASSIGNED: In a population-based case-control study, machine learning models incorporating readily available EHR data showed reasonable discrimination and risk enrichment for OHCA in the general population. Salient factors associated with OCHA risk were myriad across the cardiovascular and noncardiovascular spectrum. Public health and tailored strategies for OHCA prediction and prevention will require incorporation of this complexity.