Machine ​learning algorithms for claims data‐based prediction of in‐hospital mortality in patients with heart failure

König, Sebastian; Pellissier, Vincent; Hohenstein, Sven; Bernal, Andres; Ueberham, Laura; Meier‐Hellmann, Andreas; Kuhlen, Ralf; Hindricks, Gerhard; Bollmann, Andreas

AIMS: Models predicting mortality in heart failure (HF) patients are often limited with regard to performance and applicability. The aim of this study was to develop a reliable algorithm to compute expected in‐hospital mortality rates in HF cohorts on a population level based on administrative data comparing regression analysis with different machine learning (ML) models. METHODS AND RESULTS: Inpatient cases with primary International Statistical Classification of Diseases and Related Health Problems (ICD‐10) encoded discharge diagnosis of HF non‐electively admitted to 86 German Helios hospitals between 1 January 2016 and 31 December 2018 were identified. The dataset was randomly split 75%/25% for model development and testing. Highly unbalanced variables were removed. Four ML algorithms were applied, and all algorithms were tuned using a grid search with multiple repetitions. Model performance was evaluated by computing receiver operating characteristic areas under the curve. In total, 59 125 cases (69.8% aged 75 years or older, 51.9% female) were investigated, and in‐hospital mortality was 6.20%. Areas under the curve of all ML algorithms outperformed regression analysis in the testing dataset with values of 0.829 [95% confidence interval (CI) 0.814–0.843] for logistic regression, 0.875 (95% CI 0.863–0.886) for random forest, 0.882 (95% CI 0.871–0.893) for gradient boosting machine, 0.866 (95% CI 0.854–0.878) for single‐layer neural networks, and 0.882 (95% CI 0.872–0.893) for extreme gradient boosting. Brier scores demonstrated a good calibration especially of the latter three models. CONCLUSIONS: We introduced reliable models to calculate expected in‐hospital mortality based only on administrative routine data using ML algorithms. A broad application could supplement quality measurement programs and therefore improve future HF patient care.