Identifying potential candidates for advanced heart failure therapies using an interpretable machine learning algorithm.

Abstract

Systems level barriers to heart failure (HF) care limit access to HF advanced therapies (heart transplantation, left ventricular assist devices). There is a need for automated systems that can help clinicians ensure patients with HF are evaluated for HF advanced therapies at the appropriate time to optimize outcomes. We performed a retrospective study using the REVIVAL (Registry Evaluation of Vital Information for VADs in Ambulatory Life) and INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registries. We developed a novel machine learning model based on principles of tropical geometry and fuzzy logic that can accommodate clinician knowledge and provide recommendations regarding need for advanced therapies evaluations that are accessible to end-users. The model was trained and validated using data from 4,694 HF patients. When initiated with clinical knowledge from HF and transplant cardiologists, the model achieved an F1 score of 43.8%, recall of 51.1%, and precision of 46.9%. The model achieved comparable performance compared with other commonly used machine learning models. Importantly, our model was 1 of only 3 models providing transparent and parsimonious clinical rules, significantly outperforming the other 2 models. Eleven clinical rules were extracted from the model which can be leveraged in clinical practice. A machine learning model capable of accepting clinical knowledge and making accessible recommendations was trained to identify patients with advanced HF. While this model was developed for HF care, the methodology has multiple potential uses in other important clinical applications.