Long-term PM2.5 exposure and the clinical application of machine learning for predicting incident atrial fibrillation

Abstract

Clinical impact of fine particulate matter (PM2.5) air pollution on incident atrial fibrillation (AF) had not been well studied. We used integrated machine learning (ML) to build several incident AF prediction models that include average hourly measurements of PM2.5 for the 432,587 subjects of Korean general population. We compared these incident AF prediction models using c-index, net reclassification improvement index (NRI), and integrated discrimination improvement index (IDI). ML using the boosted ensemble method exhibited a higher c-index (0.845 [0.837–0.853]) than existing traditional regression models using CHA2DS2-VASc (0.654 [0.646–0.661]), CHADS2 (0.652 [0.646–0.657]), or HATCH (0.669 [0.661–0.676]) scores (each p < 0.001) for predicting incident AF. As feature selection algorithms identified PM2.5 as a highly important variable, we applied PM2.5 for predicting incident AF and constructed scoring systems. The prediction performances significantly increased compared with models without PM2.5 (c-indices: boosted ensemble ML, 0.954 [0.949–0.959]; PM-CHA2DS2-VASc, 0.859 [0.848–0.870]; PM-CHADS2, 0.823 [0.810–0.836]; or PM-HATCH score, 0.849 [0.837–0.860]; each interaction, p < 0.001; NRI and IDI were also positive). ML combining readily available clinical variables and PM2.5 data was found to predict incident AF better than models without PM2.5 or even established risk prediction approaches in the general population exposed to high air pollution levels.