JMIR Publications

ABSTRACT

Background:

Prevention and management of chronic diseases are the main goals of nationwide health maintenance programs. Previously widely used screening tools, such as Health Risk Appraisal, are restricted in their achievement this goal due to their limitations, such as static characteristics, accessibility, and generalizability. Hypertension is one of the most important chronic diseases requiring management via the nationwide health maintenance program, and health care providers should inform patients about their risks of complication caused by hypertension.

Objective:

Our goal was to develop and compare machine learning models predicting high-risk vascular diseases for hypertensive patients, so that they can manage their blood pressure based on their risk level.

Methods:

We used a 12-year longitudinal dataset of the nationwide sample cohort, which contains the data of 514,866 patients and allows tracking of patients’ medical history across all healthcare providers in Korea (N = 51,920). To ensure the generalizability of our models, we conducted an external validation using another national sample cohort dataset, comprising one million different patients, published by the National Health Insurance Service. From each dataset, we obtained the data of 74,535 and 59,738 patients with essential hypertension and developed machine learning models for predicting cardiovascular and cerebrovascular events. Six machine learning models were developed and compared for evaluating performances based on validation metrics.

Results:

Machine learning algorithms enabled us to detect high-risk patients based on their medical history. The long short-term memory-based algorithm outperformed in the within-test (F1-score: 0.772; external-test F1-score: 0.613), and the random forest-based algorithm of risk prediction showed better performance over other machine learning algorithms with respect to generalization (within-test F1-score: 0.757; external-test F1-score: 0.705). With respect to the number of features, in the within-test, the long-short term memory-based algorithms outperformed regardless of the number of features. However, in the external-test, the random forest-based algorithm was the best, regardless of the number of features it encountered.

Conclusions:

We developed and compared machine learning models predicting high-risk vascular diseases in hypertensive patients so that they may manage their blood pressure based on their risk level. By relying on the prediction model, a government can predict high-risk patients at the nationwide level and establish healthcare policies in advance.