JMIR Publications

ABSTRACT

Background:

Machine learning is nowadays commonly used for disease prediction, including cardiovascular disease. There is growing evidence of the effectiveness of machine learning algorithms for stroke risk prediction models.

Objective:

A systematic review was conducted to identify and comprehensively evaluate the available evidence.

Methods:

Relevant studies were identified from the three electronic databases (i) MEDLINE via Pubmed, (ii) Scopus, and (iii) IEEE Xplore from inception to 1st December 2020. Out of 12,626 studies identified, 40 used machine learning for ischemic or hemorrhagic stroke risk prediction models.

Results:

Synthesis without meta-analysis identified that a boosting algorithm (median C-statistics = 0.9 (interquartile range [IQR]: 0.88-0.92)), and neural network (median C-statistic = 0.80 (IQR: 0.79-0.86)) performed best among ML models in the low risk of bias studies. Conversely, the support vector machine performed best in overall (both low and high risk of bias) studies (median C-statistic = 0.89 (IQR: 0.81-0.97)).

Conclusions:

The systematic review found promising results of the ML algorithm model performances compare with the gold standard conventional models, such as FSRP (C-statistic 0.653) and revised FSRP (C-statistic 0.716). In term of the algorithm, boosting and neural networks are robust, but are considered as black-box models, since they are composed of non-linearity and complex algorithms. It remains questionable whether a physician would adapt these algorithms to use in a real clinical setting. Moreover, less than half of the studies (16 out of 40) were at low risk of bias in our systematic review. More researches with good methodology and study design, alongside explainable and good performance models, may become available in the future. Clinical Trial: The International Prospective Register of Systematic Reviews (PROSPERO) database (ID: CRD42021234081).