John Pfeifer, Sushravya M Raghunath, Alvaro Ulloa, Arun Nemani, Tanner Carbonati, Linyuan Jing, David vanMaanen, Dustin Hartzel, Jeffrey Ruhl, Nathan J Stoudt, Kipp W Johnson, Noah Zimmerman, Joseph Leader, H Lester Kirchner, Christoph Griessenauer, Ashraf Hafez, Christopher Good, Brandon Fornwalt, Christopher M Haggerty
Background: Atrial fibrillation (AF) is associated with stroke, especially when AF goes undetected. Deep neural networks (DNN) can predict incident AF from a 12-lead resting ECG. We hypothesize that use of a DNN to predict new onset AF from an ECG may identify patients at risk of sustaining a potentially preventable AF-related stroke.
Methods: We trained a DNN model to predict new-onset AF using 382,604 ECGs prior to 2010. We then evaluated the model performance on a test set of ECGs from 2010 through 2014 linked to patients in an institutional stroke registry. There were 181,969 patients in the test set with at least one ECG and no prior history of AF. Of those patients 3,497 (1.9%) had a stroke following an ECG that did not show AF. Within the set of patients with stroke, 375 had the stroke within 3 years of the ECG and were diagnosed with new AF between -3 and 365 days of the stroke. We considered these potentially preventable AF-related strokes. We report the sensitivity and positive predictive value (PPV) of the model for appropriately risk stratifying these 375 patients who sustained a potentially preventable AF-related stroke.
Results: We used Fβ scores to identify different risk prediction thresholds (operating points) for the model. Operating points chosen by F0.5, F1, and F2 scores identified 4, 12, and 21% of the population as high risk for the development of AF within 1 year (Figure 1). Screening 1, 4, 12, and 21% of the overall population resulted in PPV of 28, 21, 15, and 12%, respectively, for identification of new onset AF in one year. Using those same thresholds yielded sensitivities of 4, 17, 45, and 62% for identifying potentially preventable AF-related strokes. The different risk prediction thresholds resulted in a low (120-162) number needed to screen to detect one potentially preventable AF-related stroke at 3 years.
Conclusions: Use of a deep learning model to predict new onset AF may identify patients at high risk of sustaining a potentially preventable AF-related stroke.
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