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      Survey and Evaluation of Hypertension Machine Learning Research

      research-article
      , MSc 1 , , MSc 1 , , BS 2 , , MS 3 , , MBChB 1 , , MBChB 1 , , MS 3 , , MSc 4 , , MS 3 , , MBBS 5 , , PhD 1 , 6 , , MSc 1 , , MSc 1 , , MBChB 1 , , MBChB 1 , , MSc 1 , , MBBS 7 , , MD 8 , , PhD 3 , , PhD 1 , , MBBS, PhD 9 , , MD, PhD 10 , , MD, MBA 11 , , PhD 3 , , , MD, PhD 1 ,
      Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
      John Wiley and Sons Inc.
      artificial intelligence, hypertension, machine learning, reporting quality, Hypertension, High Blood Pressure, Machine Learning

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          Abstract

          Background

          Machine learning (ML) is pervasive in all fields of research, from automating tasks to complex decision‐making. However, applications in different specialities are variable and generally limited. Like other conditions, the number of studies employing ML in hypertension research is growing rapidly. In this study, we aimed to survey hypertension research using ML, evaluate the reporting quality, and identify barriers to ML's potential to transform hypertension care.

          Methods and Results

          The Harmonious Understanding of Machine Learning Analytics Network survey questionnaire was applied to 63 hypertension‐related ML research articles published between January 2019 and September 2021. The most common research topics were blood pressure prediction (38%), hypertension (22%), cardiovascular outcomes (6%), blood pressure variability (5%), treatment response (5%), and real‐time blood pressure estimation (5%). The reporting quality of the articles was variable. Only 46% of articles described the study population or derivation cohort. Most articles (81%) reported at least 1 performance measure, but only 40% presented any measures of calibration. Compliance with ethics, patient privacy, and data security regulations were mentioned in 30 (48%) of the articles. Only 14% used geographically or temporally distinct validation data sets. Algorithmic bias was not addressed in any of the articles, with only 6 of them acknowledging risk of bias.

          Conclusions

          Recent ML research on hypertension is limited to exploratory research and has significant shortcomings in reporting quality, model validation, and algorithmic bias. Our analysis identifies areas for improvement that will help pave the way for the realization of the potential of ML in hypertension and facilitate its adoption.

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          Most cited references78

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          Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.

          Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.
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            • Article: not found

            Dissecting racial bias in an algorithm used to manage the health of populations

            Health systems rely on commercial prediction algorithms to identify and help patients with complex health needs. We show that a widely used algorithm, typical of this industry-wide approach and affecting millions of patients, exhibits significant racial bias: At a given risk score, Black patients are considerably sicker than White patients, as evidenced by signs of uncontrolled illnesses. Remedying this disparity would increase the percentage of Black patients receiving additional help from 17.7 to 46.5%. The bias arises because the algorithm predicts health care costs rather than illness, but unequal access to care means that we spend less money caring for Black patients than for White patients. Thus, despite health care cost appearing to be an effective proxy for health by some measures of predictive accuracy, large racial biases arise. We suggest that the choice of convenient, seemingly effective proxies for ground truth can be an important source of algorithmic bias in many contexts.
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              • Article: not found

              Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network

              Computerized electrocardiogram (ECG) interpretation plays a critical role in the clinical ECG workflow1. Widely available digital ECG data and the algorithmic paradigm of deep learning2 present an opportunity to substantially improve the accuracy and scalability of automated ECG analysis. However, a comprehensive evaluation of an end-to-end deep learning approach for ECG analysis across a wide variety of diagnostic classes has not been previously reported. Here, we develop a deep neural network (DNN) to classify 12 rhythm classes using 91,232 single-lead ECGs from 53,549 patients who used a single-lead ambulatory ECG monitoring device. When validated against an independent test dataset annotated by a consensus committee of board-certified practicing cardiologists, the DNN achieved an average area under the receiver operating characteristic curve (ROC) of 0.97. The average F1 score, which is the harmonic mean of the positive predictive value and sensitivity, for the DNN (0.837) exceeded that of average cardiologists (0.780). With specificity fixed at the average specificity achieved by cardiologists, the sensitivity of the DNN exceeded the average cardiologist sensitivity for all rhythm classes. These findings demonstrate that an end-to-end deep learning approach can classify a broad range of distinct arrhythmias from single-lead ECGs with high diagnostic performance similar to that of cardiologists. If confirmed in clinical settings, this approach could reduce the rate of misdiagnosed computerized ECG interpretations and improve the efficiency of expert human ECG interpretation by accurately triaging or prioritizing the most urgent conditions.
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                Author and article information

                Contributors
                bina.joe@utoledo.edu
                sandosh.padmanabhan@glasgow.ac.uk
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                29 April 2023
                02 May 2023
                : 12
                : 9 ( doiID: 10.1002/jah3.v12.9 )
                : e027896
                Affiliations
                [ 1 ] School of Cardiovascular and Metabolic Health University of Glasgow Glasgow United Kingdom
                [ 2 ] Mayo Clinic Alix School of Medicine Rochester MN
                [ 3 ] Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology University of Toledo College of Medicine and Life Sciences Toledo OH
                [ 4 ] Institute of Genetics and Cancer University of Edinburgh Edinburgh United Kingdom
                [ 5 ] Lady Hardinge Medical College New Delhi India
                [ 6 ] Department of Pharmacology and Toxicology, Faculty of Medicine Umm Al Qura University Makkah Saudi Arabia
                [ 7 ] College of Medicine Mohammed Bin Rashid University of Medicine and Health Sciences Dubai UAE
                [ 8 ] Department of Internal Medicine TriStar Centennial Medical Center, HCA Healthcare Nashville TN
                [ 9 ] School of Medicine Deakin University Geelong Australia
                [ 10 ] Department of Biomedical Informatics University of Pittsburgh Pittsburgh PA
                [ 11 ] Department of Anesthesiology and Critical Care Medicine Mayo Clinic Rochester MN
                Author notes
                [*] [* ] Correspondence to: Sandosh Padmanabhan, MD, PhD, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK. Email: sandosh.padmanabhan@ 123456glasgow.ac.uk

                Bina Joe, PhD, Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614. Email: bina.joe@ 123456utoledo.edu

                [*]

                C. du Toit and T. Q. B. Tran contributed equally.

                Author information
                https://orcid.org/0000-0002-7221-6965
                https://orcid.org/0000-0001-6829-6432
                https://orcid.org/0000-0002-0583-8916
                https://orcid.org/0000-0002-1939-6338
                https://orcid.org/0000-0001-8515-9018
                https://orcid.org/0000-0003-1010-5474
                https://orcid.org/0000-0001-6772-2540
                https://orcid.org/0000-0003-0814-9478
                https://orcid.org/0000-0002-6316-7006
                https://orcid.org/0000-0002-6453-754X
                https://orcid.org/0009-0008-8049-8414
                https://orcid.org/0000-0002-6976-3714
                https://orcid.org/0000-0003-4022-5880
                https://orcid.org/0000-0002-0701-7628
                https://orcid.org/0000-0002-6495-9128
                https://orcid.org/0000-0002-3887-3566
                https://orcid.org/0000-0001-6596-647X
                https://orcid.org/0000-0002-5824-4900
                https://orcid.org/0000-0002-2079-8684
                https://orcid.org/0000-0002-4383-3411
                https://orcid.org/0000-0002-2385-7061
                https://orcid.org/0000-0003-3869-5808
                Article
                JAH38402 JAHA/2022/027896-T
                10.1161/JAHA.122.027896
                10227215
                37119074
                67d8431b-4b57-4782-8d5f-811b15321f3e
                © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 December 2022
                : 27 March 2023
                Page count
                Figures: 3, Tables: 0, Pages: 9, Words: 6293
                Funding
                Funded by: British Heart Foundation Centre of Excellence Award
                Award ID: SIPF00007/1
                Award ID: RE/18/6/34217
                Funded by: United Kingdom Research and Innovation Strength in Places Fund
                Funded by: British Heart Foundation , doi 10.13039/501100000274;
                Award ID: FS/MBPhD/22/28005
                Funded by: National Heart Lung and Blood Institute
                Funded by: National Institutes of Health , doi 10.13039/100000002;
                Categories
                Original Research
                Original Research
                Hypertension
                Custom metadata
                2.0
                02 May 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.8 mode:remove_FC converted:07.05.2023

                Cardiovascular Medicine
                artificial intelligence,hypertension,machine learning,reporting quality,high blood pressure

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