A novel ontology and machine learning driven hybrid cardiovascular clinical prognosis as a complex adaptive clinical system

Purpose: This multidisciplinary industrial research project sets out to develop a hybrid clinical decision support mechanism (inspired by ontology and machine learning driven techniques) by combining evidence, extrapolated through legacy patient data to facilitate cardiovascular preventative care. Methods: The proposed cardiovascular clinical decision support framework comprises of two novel key components:(1) Ontology driven clinical risk assessment and recommendation system (ODCRARS) (2) Machine learning driven prognostic system (MLDPS). State of the art machine learning and feature selection methods are utilised for the prognostic modelling purposes. The ODCRARS is a knowledge-based system which is based on clinical expert’s knowledge, encoded in the form of clinical rules engine to carry out cardiac risk assessment for various cardiovascular diseases. The MLDPS is a non knowledge-based/data driven system which is developed using state of the art machine learning and feature selection techniques applied on real patient datasets. Clinical case studies in the RACPC, heart disease and breast cancer domains are considered for the development and clinical validation purposes. For the purpose of this paper, clinical case study in the RACPC/chest pain domain will be discussed in detail from the development and validation perspective. Results: The proposed clinical decision support framework is validated through clinical case studies in the cardiovascular domain. This paper demonstrates an effective cardiovascular decision support mechanism for handling inaccuracies in the clinical risk assessment of chest pain patients and help clinicians effectively distinguish acute angina/cardiac chest pain patients from those with other causes of chest pain. Conclusion: 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. Various chest pain risk assessment prototypes have been developed and deployed online for further clinical trials.