Construction of a Non-Mutually Exclusive Decision Tree for Medication Recommendation of Chronic Heart Failure

被引:3
作者
Bai, Yongyi [1 ,2 ,3 ]
Yao, Haishen [4 ]
Jiang, Xuehan [4 ]
Bian, Suyan [1 ,2 ,3 ]
Zhou, Jinghui [4 ]
Sun, Xingzhi [4 ]
Hu, Gang [4 ]
Sun, Lan [5 ]
Xie, Guotong [4 ]
He, Kunlun [3 ,6 ]
机构
[1] Chinese Peoples Liberat Army Gen Hosp, Dept Cardiol, Med Ctr 2, Beijing, Peoples R China
[2] Chinese Peoples Liberat Army Gen Hosp, Natl Clin Res Ctr Geriatr Dis, Beijing, Peoples R China
[3] Chinese Peoples Liberat Army Gen Hosp, Beijing Key Lab Precis Med Chron Heart Failure, Beijing, Peoples R China
[4] Ping An Hlth Technol, Beijing, Peoples R China
[5] Chinese Acad Med Sci & Peking Union Med Coll, Inst Mat Med, Beijing, Peoples R China
[6] Chinese Peoples Liberat Army Gen Hosp, Res Ctr Med Big Data, Med Innovat Res Div, Beijing, Peoples R China
基金
英国科研创新办公室; 中国国家自然科学基金;
关键词
decision tree; medication recommendation; clinical decision support system (CDSS); chronic heart failure; treatment; machine learning; GUIDELINES;
D O I
10.3389/fphar.2021.758573
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Objective: Although guidelines have recommended standardized drug treatment for heart failure (HF), there are still many challenges in making the correct clinical decisions due to the complicated clinical situations of HF patients. Each patient would satisfy several recommendations, meaning the decision tree of HF treatment should be nonmutually exclusive, and the same patient would be allocated to several leaf nodes in the decision tree. In the current study, we aim to propose a way to ensemble a nonmutually exclusive decision tree for recommendation system for complicated diseases, such as HF.Methods: The nonmutually exclusive decision tree was constructed via knowledge rules summarized from the HF clinical guidelines. Then similar patients were defined as those who followed the same pattern of leaf node allocation according to the decision tree. The frequent medication patterns for each similar patient were mined using the Apriori algorithms, and we also carried out the outcome prognosis analyses to show the capability for the evidence-based medication recommendations of our nonmutually exclusive decision tree.Results: Based on a large database that included 29,689 patients with 84,705 admissions, we tested the framework for HF treatment recommendation. In the constructed decision tree, the HF treatment recommendations were grouped into two independent parts. The first part was recommendations for new cases, and the second part was recommendations when patients had different historical medication. There are 14 leaf nodes in our decision tree, and most of the leaf nodes had a guideline adherence of around 90%. We reported the top 10 popular similar patients, which accounted for 32.84% of the whole population. In addition, the multiple outcome prognosis analyses were carried out to assess the medications for one of the subgroups of similar patients. Our results showed even for the subgroup of the same similar patients that no one medication pattern would benefit all outcomes.Conclusion: In the present study, the methodology to construct a nonmutually exclusive decision tree for medication recommendations for HF and its application in CDSS was proposed. Our framework is universal for most diseases and could be generally applied in developing the CDSS for treatment.
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页数:11
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