Detecting transthyretin amyloid cardiomyopathy (ATTR-CM) using machine learning: an evaluation of the performance of an algorithm in a UK setting

Tsang, Carmen; Huda, Ahsan; Norman, Max; Dickerson, Carissa; Leo, Vincenzo; Brownrigg, Jack; Mamas, Mamas; Elliott, Perry

Abstract

Objective: The aim of this study was to evaluate the potential real-world application of a machine learning (ML) algorithm, developed and trained on heart failure (HF) cohorts in the USA, to detect patients with undiagnosed wild type cardiac amyloidosis (ATTRwt) in the UK.

Design: In this retrospective observational study, anonymised, linked primary and secondary care data (Clinical Practice Research Datalink GOLD and Hospital Episode Statistics, respectively, were used to identify patients diagnosed with HF between 2009 and 2018 in the UK. International Classification of Diseases (ICD)-10 clinical modification codes were matched to equivalent Read (primary care) and ICD-10 WHO (secondary care) diagnosis codes used in the UK. In the absence of specific Read or ICD-10 WHO codes for ATTRwt, two proxy case definitions (definitive and possible cases) based on the degree of confidence that the contributing codes defined true ATTRwt cases were created using ML.

Primary outcome measure: Algorithm performance was evaluated primarily using the area under the receiver operating curve (AUROC) by comparing the actual versus algorithm predicted case definitions at varying sensitivities and specificities.

Results: The algorithm demonstrated strongest predictive ability when a combination of primary care and secondary care data were used (AUROC: 0.84 in definitive cohort and 0.86 in possible cohort). For primary care or secondary care data alone, performance ranged from 0.68 to 0.78.

Conclusion: The ML algorithm, despite being developed in a US population, was effective at identifying patients that may have ATTRwt in a UK setting. Its potential use in research and clinical care to aid identification of patients with undiagnosed ATTRwt, possibly enabling earlier diagnosis in the disease pathway, should be investigated.

Citation

Tsang, C., Huda, A., Norman, M., Dickerson, C., Leo, V., Brownrigg, J., Mamas, M., & Elliott, P. (2023). Detecting transthyretin amyloid cardiomyopathy (ATTR-CM) using machine learning: an evaluation of the performance of an algorithm in a UK setting. BMJ Open, 13(10), Article e070028. https://doi.org/10.1136/bmjopen-2022-070028

• Journal Article Type: Article
• Acceptance Date: Oct 11, 2023
• Online Publication Date: Oct 29, 2023
• Publication Date: Oct 1, 2023
• Deposit Date: Nov 6, 2023
• Publicly Available Date: Nov 6, 2023
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Issue: 10
• Article Number: e070028
• DOI: https://doi.org/10.1136/bmjopen-2022-070028
• Keywords: cardiomyopathy, adult cardiology, cardiology
• Public URL: https://keele-repository.worktribe.com/output/619152