Predictive Analytics, Healthcare and a Life much awaited

Jyotika is 61 years old and lives in a small town in Lucknow and is suffering from Diabetes for the past 14 years. She is coping well with fair HB1AC values and lifestyle management. Recently, Jyotika felt that she is not able to handle sunlight well and feels that her vision is a bit blurred- she is speculating cataract and shows up at Dr. Narula’s Clinic. Dr. Narula is the Chief Ophthalmologist and has more than 35 years of experience and currently runs a Polyclinic out of Lucknow, UP. Jyotika gets successfully operated for Cataract and is discharged the same day. Within 13 days of discharge, Jyotika is admitted again but this time because of a Cardiac Disease. The family is speculating if this has something to do with the recent cataract surgery. Dr Reddy, Head of Department, Cardiology shows up and makes a comment to the family and Nurse- Well! Oxidative damage to proteins in the human lens is believed to be important in the etiology of age-related cataract. Because free radical-mediated oxidative damage to lipoproteins may accelerate atherosclerosis, the authors hypothesized that the development of cataract might be a marker for such damage and therefore might be associated with future risk of coronary heart disease (CHD).  Mahesh, husband of Jyotika is not very happy with this. He believes that the doctors demonstrated clear negligence when Jyotika was admitted last time and provided no warning signs related to any possibility of a heart disease.

Is there a way that this story would have been different and more assuring for the patient?

Predictors like Physiological data (systolic blood pressure); Predictive Drugs usage and context (drug use of alpha blockers, beta blockers, beta agonists), Previous disease history (especially COPD, Lifestyle and environmental factors (age, smoking, and other coronary risk factors) can help determine risk for the population well in advance with Predictive analytics in action.

Quick stats- In the United States, 1 in 4 women dies from heart disease. In fact, coronary heart disease (CHD)—the most common type of heart disease—is the #1 killer of both men and women in the United States. Also, a greater proportion of women (52 percent) than men (42 percent) with myocardial infarction die of sudden cardiac death before reaching the hospital.

Companies like Enlightiks, an advanced Predictive analytics company based in India, have developed interesting risk stratification modules that can crawl of millions of health records in a population to understand patterns, trends, patient similarity metrics and natural language processing system that also takes into context unstructured data like Physician notes and discharge documents that are not often taken into account for analysis.

Data goes through normalisation in a smart grid atmosphere and is then put into context to further do analysis based on simple algorithms like Framingham’s scale coupled with patient similarity study, isomorphism of patient graphs in a population, building cohorts and then aligning the data to the outcomes. This provides more complete and accurate understanding of each patient.

While studying the Prospective study of cataract extraction and risk of coronary heart disease in women 60,657 women aged 45--63 years were followed. These women were without known coronary disease, stroke, or cancer in 1984.During 10 years of follow-up (674,283 person-years), the authors of this report (see source) documented 887 incident cases of CHD and 2,322 deaths.

After adjustment for age, smoking, and other coronary risk factors, cataract extraction was significantly associated with higher risk of CHD (relative risk (RR) = 1.88, 95% confidence interval (CI): 1.41, 2.50) for total CHD, 2.44 (95% CI: 1.54, 3.89) for fatal CHD, and 1.63 (95% CI: 1.14, 2.34) for nonfatal myocardial infarction). The positive association between cataract extraction and total CHD was stronger among women with a history of diabetes (RR = 2.80, 95% CI: 1.77, 4.42) than among those without reported diabetes (RR = 1.51, 95 percent CI: 1.04, 2.18). In multivariate analyses, cataract extraction was associated with significantly increased overall mortality (RR = 1.37, 95 percent CI: 1.13, 1.66), which was entirely explained by the increased mortality from cardiovascular disease (RR = 1.84, 95% CI: 1.29, 2.64). These findings are compatible with current hypotheses relating oxidative damage and tissue aging to the development of cataract and CHD.

Data mining and data analytics has been of immense importance to many different fields as we witness the evolution of data sciences over recent years. Biostatistics and Medical Informatics has proved to be the foundation of many modern biological theories and analysis techniques. These are the fields which applies data mining practices along with statistical models to discover hidden trends from data that comprises of biological experiments or procedures on different entities.

In case of Jyotika if risk stratification was possible, it would have allowed advanced preventative measures and would have also help bring down healthcare costs especially for a country like India where 80% of healthcare expenditure is out of pocket. The claims and hospital admission would have been carefully planned or avoidable. Also, such measures would have led to better patient satisfaction.