Abstract
Atrial fibrillation (AF) is the most common arrhythmia and significantly increases stroke risk. This risk is effectively managed by oral anticoagulation. Recent studies using national registry data indicate increased use of anticoagulation resulting from changes in guidelines and the availability of newer drugs. The aim of this study is to develop and validate an open source risk scoring pipeline for free-text electronic health record data using natural language processing. AF patients discharged from 1st January 2011 to 1st October 2017 were identified from discharge summaries (N = 10,030, 64.6% male, average age 75.3 ± 12.3 years). A natural language processing pipeline was developed to identify risk factors in clinical text and calculate risk for ischaemic stroke (CHA2DS2-VASc) and bleeding (HAS-BLED). Scores were validated vs two independent experts for 40 patients. Automatic risk scores were in strong agreement with the two independent experts for CHA2DS2-VASc (average kappa 0.78 vs experts, compared to 0.85 between experts). Agreement was lower for HAS-BLED (average kappa 0.54 vs experts, compared to 0.74 between experts). In high-risk patients (CHA2DS2-VASc ≥2) OAC use has increased significantly over the last 7 years, driven by the availability of DOACs and the transitioning of patients from AP medication alone to OAC. Factors independently associated with OAC use included components of the CHA2DS2-VASc and HAS-BLED scores as well as discharging specialty and frailty. OAC use was highest in patients discharged under cardiology (69%). Electronic health record text can be used for automatic calculation of clinical risk scores at scale. Open source tools are available today for this task but require further validation. Analysis of routinely collected EHR data can replicate findings from large-scale curated registries.
Highlights
[1] this risk can be substantially reduced by oral anticoagulants (OAC), warfarin has historically been underused in Atrial fibrillation (AF)
There has been a substantial increase in the proportion of AF patients at high risk of stroke (CHA2DS2-VASc 2) prescribed an OAC, with OAC use rising from 42% in 2011 to 62% in 2017
There has been a reduction in the use of warfarin and an increase in direct oral anticoagulant (DOAC) prescription, such that in 2017 more patients were discharged on a DOAC than warfarin
Summary
Atrial fibrillation (AF) affects 2% of the UK population and significantly increases stroke risk. [1] this risk can be substantially reduced by oral anticoagulants (OAC), warfarin has historically been underused in AF. Over the last decade the antithrombotic landscape has changed significantly with: (1) the introduction of direct oral anticoagulants (DOACs), and (2) the updated UK NICE 2014 AF guidelines[2] which introduced the CHA2DS2-VASc[3] and HAS-BLED[4] risk calculators and removed endorsement of the use of antiplatelet agents for stroke prevention. Whilst free text is information-dense to a human reader, to be useful for computational analysis it requires conversion to a structured format. Performing this process manually is very labour-intensive. Given the enormous volume of clinical data contained solely in written notes[10], extracting this information is critical to realizing the full potential of EHRs
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
