NATURAL LANGUAGE PROCESSING TO ASSESS ATHEROSCLEROTIC CARDIOVASCULAR DISEASE, DIABETES, AND FAMILIAL HYPERCHOLESTEROLEMIA LIPID MANAGEMENT IN CANADA
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Keywords
Atherosclerotic Cardiovascular Disease (ASCVD), LDL-C, lipid-lowering therapy, Natural Language Processing
Abstract
Background: Elevated low-density lipoprotein cholesterol (LDL-C) leads to atherosclerotic cardiovascular disease (ASCVD). This study assessed treatment patterns & achievement of guideline-recommended LDL-C levels in Canadian patients with ASCVD, diabetes mellitus (DM), or familial hypercholesterolemia (FH).
Methods: Natural language processing (NLP) was utilized to extract demographic, clinical characteristics, and lipid lowering treatment (LLT) information from de-identified electronic health records of patients from cardiology or internal medicine settings in 4 provinces. The study period spanned from 1-January-2016 to 30-November-2020, and included identification, baseline, and 12-month follow-up periods.
Results: A total of 10,992 patients were identified; ASCVD (n=9,415), DM (n=1,132), and FH (n=445). Failure to achieve recommended LDL-C levels was common at baseline (38% ASCVD, 38% DM, and 75% FH) and at follow-up for patients with uncontrolled baseline LDL-C (43% ASCVD, 55% DM, and 52% FH). There was no documented LLT in 33-49% of patients with uncontrolled baseline LDL-C. LDL-C was not documented in 45%, 59%, and 23% of patients with ASVCD, DM, and FH, respectively. LDL-C levels decreased over time in all patients, with the largest decrease in patients receiving PCSK9 monoclonal antibodies, ezetimibe, or high intensity statins.
Conclusions: The present study revealed that over a third of patients with uncontrolled baseline LDL-C lacked documented LLT, almost 50% of patients did not attain recommended LDL-C levels, and that treatment modification in patients with uncontrolled LDL-C could have been more intensive. Our findings were consistent with studies using traditional administrative datasets, suggesting a promising role for NLP in future quality improvement initiatives and research.
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Lawrence A. Leiter, MD
Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and University of Toronto, Toronto, ON, Canada
Taha Bandukwala, MD
Ensho Health, Toronto, ON, Canada
Francois Leblond, MSc, PhD
Novartis Pharmaceuticals Canada Inc., Montreal, QC, Canada
Andrea J. Lavoie, BSc, MD, FRCPC
University of Saskatchewan, Regina, SK, Canada
GB John Mancini, MD
Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
Carlos Rojas-Fernandez, PharmD
Novartis Pharmaceuticals Canada Inc., Montreal, QC, Canada