A novel cardiovascular decision support framework for effective clinical risk assessment

The aim of this study is to help improve the diagnostic and performance capabilities of Rapid Access Chest Pain Clinics (RACPC), by reducing delay and inaccuracies in the cardiovascular risk assessment of patients with chest pain by helping clinicians effectively distinguish acute angina patients from those with other causes of chest pain. Key to our new approach is (1) an intelligent prospective clinical decision support framework for primary and secondary care clinicians, (2) learning from missing/impartial clinical data using Bernoulli mixture models and Expectation Maximisation (EM) techniques, (3) utilisation of state-of-the-art feature section, pattern recognition and data mining techniques for the development of intelligent risk prediction models for cardiovascular patients. The study cohort comprises of 632 patients suspected of cardiac chest pain. A retrospective data analysis of the clinical studies evaluating clinical risk factors for chest pain patients was performed for the development of RACPC specific risk assessment models to distinguish between cardiac and non cardiac chest pain. A comparative analysis case study of machine learning methods was carried out for predicting RACPC clinical outcomes using real patient data acquired from Raigmore Hospital in Inverness, UK. The proposed framework was also validated using the University of Cleveland's Heart Disease dataset which contains 76 attributes, but all published experiments refer to using a subset of 14 of them. Experiments with the Cleveland database (based on 18 clinical features of 270 patients) were concentrated on attempting to distinguish the presence of heart disease (values 1, 2, 3, 4) from absence (value 0). The new clinical models, having been evaluated in clinical practice, resulted in very good predictive power, demonstrating general performance improvement over benchmark multivariate statistical classifiers. As part of these case studies, various online RACPC risk assessment prototypes have been developed which are being deployed in the clinical setting (NHS Highland) for clinical trial purposes.