{"doi":"10.1016/j.jacadv.2022.100123","title":"Augmented Intelligence to Identify Patients With Advanced Heart Failure in an Integrated Health System","abstract":"BACKGROUND: Timely referral for specialist evaluation in patients with advanced heart failure (HF) is a Class 1 recommendation. However, the transition from stage C HF to advanced or stage D HF often goes undetected in routine care, resulting in delayed referral and higher mortality rates. OBJECTIVES: The authors sought to develop an augmented intelligence-enabled workflow using machine learning to identify patients with stage D HF and streamline referral. METHODS: We extracted data on HF patients with encounters from January 1, 2007, to November 30, 2020, from a HF registry within a regional, integrated health system. We created an ensemble machine learning model to predict stage C or stage D HF and integrated the results within the electronic health record. RESULTS: In a retrospective data set of 14,846 patients, the model had a good positive predictive value (60%) and low sensitivity (25%) for identifying stage D HF in a 100-person, physician-reviewed, holdout test set. During prospective implementation of the workflow from April 1, 2021, to February 15, 2022, 416 patients were reviewed by a clinical coordinator, with agreement between the model and the coordinator in 50.3% of stage D predictions. Twenty-four patients have been scheduled for evaluation in a HF clinic, 4 patients started an evaluation for advanced therapies, and 1 patient received a left ventricular assist device. CONCLUSIONS: An augmented intelligence-enabled workflow was integrated into clinical operations to identify patients with advanced HF. Endeavors such as this require a multidisciplinary team with experience in design thinking, informatics, quality improvement, operations, and health information technology, as well as dedicated resources to monitor and improve performance over time.","journal":"JACC Advances","year":2022,"id":256852,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":19,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9546,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":906187,"name":"R. Kannan Mutharasan","orcid":"0000-0003-2831-5103","position":1,"is_corresponding":false},{"id":378369,"name":"Aditya Kumar Sharma","orcid":"0000-0002-1085-5665","position":2,"is_corresponding":false},{"id":881058,"name":"Maia Jacobs","orcid":"0000-0001-8500-0277","position":3,"is_corresponding":false},{"id":825566,"name":"Kaleigh Powers","orcid":"0000-0001-9486-8932","position":4,"is_corresponding":false},{"id":906692,"name":"Susan Lehrer","orcid":null,"position":5,"is_corresponding":false},{"id":105178,"name":"Firas Wehbe","orcid":"0000-0002-3984-9584","position":6,"is_corresponding":false},{"id":906693,"name":"Jason Ronald","orcid":null,"position":7,"is_corresponding":false},{"id":906694,"name":"Lindsay Pifer","orcid":null,"position":8,"is_corresponding":false},{"id":536666,"name":"Jonathan D. Rich","orcid":"0000-0002-2370-5252","position":9,"is_corresponding":false},{"id":296345,"name":"Kambiz Ghafourian","orcid":"0000-0001-8141-0498","position":10,"is_corresponding":false},{"id":906188,"name":"Anjan Tibrewala","orcid":"0000-0002-3376-7748","position":11,"is_corresponding":false},{"id":493630,"name":"Patrick M. McCarthy","orcid":"0000-0001-6729-2405","position":12,"is_corresponding":false},{"id":58247,"name":"Yuan Luo","orcid":"0000-0003-0195-7456","position":13,"is_corresponding":false},{"id":906189,"name":"Duc Thinh Pham","orcid":"0000-0002-5853-764X","position":14,"is_corresponding":false},{"id":233710,"name":"Jane E. Wilcox","orcid":"0000-0002-9272-7623","position":15,"is_corresponding":false},{"id":335339,"name":"Faraz S. 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