PROTECT: optima4BP 2.0: prediction of Optimal Treatment and Route to achieve and maintain BP Target

保护：optima4BP 2.0：预测最佳治疗和路线以实现和维持血压目标

• 批准号: 10159301
• 负责人: Gabriela Voskerician
• 金额: $ 71.6万
• 依托单位: OPTIMA INTEGRATED HEALTH, INC.
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10159301
• 关键词: Acute; Adverse drug event; Adverse event; Antihypertensive Agents; Artificial Intelligence; Blood Pressure; California; Cessation of life; Clinical; Clinical Trials; Confidential Information; Data; Development; Diabetes Mellitus; Diagnosis; Drug Combinations; Enrollment; Euclidean Space; Exclusion; Foundations; Gender; Generations; Goals; Guidelines; Health; Heart failure; Hypertension; Incidence; Individual; Intervention; Intervention Trial; Learning; Life; Lipids; Logic; Medical center; Mind; Modeling; Modification; Myocardial Infarction; Names; Nature; Nurses; Outcome; Patients; Performance; Pharmaceutical Preparations; Pharmacists; Pharmacological Treatment; Pharmacotherapy; Phase; Physicians; Preparation; Process; Protocols documentation; Resources; Route; Safety; San Francisco; Seminal; Source; Standardization; Stroke; Testing; Time; Training; Universities; Visit; Women' s Health; Women' s Role; Work; base; blood pressure intervention; cardiovascular risk factor; clinical care; clinically relevant; commercial application; comparative efficacy; data mining; data quality; hypertension treatment; innovation; optimal treatments; patient population; prevent; processing speed; response; stroke incidence; stroke risk; success

Need. In the US, 40 million patients with hypertension (HTN) have their blood pressure (BP) uncontrolled. BP above clinical Target even for a few months increases the risk for stroke (35-40%), heart failure (HF) (up to 64%), myocardial infarction (MI) (15-25%). Physician-nurse-pharmacist resource-intensive demonstrations in achieving & maintaining BP Target have shown promising results, but their real-life deployment was found unsustainable long-term. As a result, a process-standardized and sustainable solution is acutely needed. Solution. In response to this need, Optima Integrated Health developed optima4BP 1.0. It is a first-in-class artificial intelligence (AI) that simulates the process of clinical reasoning undertaken by the treating physician in optimizing the anti-HTN treatment towards BP Target. Just like the physician, optima4BP 1.0 cannot determine upfront the needed Optimal Treatment (OT) to achieve & maintain BP Target for 1-2 years. PROTECT [optima4BP 2.0: prediction of Optimal Treatment and route to achieve and maintain BP Target] proposes to establish upfront the personalized OT. The OT can then be used to select the shortest and safest treatment modification route needed to achieve & maintain BP Target. Phase II Goal. Build optima4BP 2.0. Phase I. Phase I Prior Work demonstrated that k-Nearest Neighbor (kNN), an AI model, can predict with ≥ 80% confidence the correct anti-HTN treatment, when compared to physician decision. Phase II. optima4BP 2.0 will predict the Optimal Treatment and route to achieve & maintain BP Target. Optimal Treatment data-mining source. PROTECT will use the SPRINT (Systolic Blood Pressure Intervention Trial, 2015) and ACCORD (Action to Control Cardiovascular Risk in Diabetes, 2010) clinical trial data. They represent the foundation of the most current anti-HTN treatment management national guidelines. Aim 1. Build kNN. Hypothesis. kNN can predict the proximity (clinical relevance) of a patient to an Optimal Treatment (OT). Milestone. Achieve ≥ 90% accuracy of prediction to physician decision. Phase I Data Preparation protocol will be applied to the SPRINT & ACCORD data. Then, the kNN Ensemble Learning function will be built to select the Optimal Treatment with the highest demonstrated efficacy by comparing the choice from 3 computational approaches developed and tested during Phase I. Aim 2. Build the Optimal Treatment Route (OTR). Hypothesis. Knowing the Current and Optimal Treatment (OT), an OTR can be built. Milestone. Safest Route: Achieve 100% exclusion of treatments that led to an adverse event in similar patient populations. Shortest Route: Achieve ≥30% reduction in number of treatment changes compared to physician route. The OTR will be built by comparing at each Step on the Route how similar each Candidate Treatment is to the OT through a computed similarity assessment. optima4BP 2.0 aims to establish a process-standardized & sustainable solution with the goal of reducing the incidence of stroke, HF, MI and death resulting from uncontrolled hypertension.

需要。在美国，4000万高血压(HTN)患者的血压(BP)不受控制。 即使血压高于临床目标数月，也会增加中风(35%-40%)、心力衰竭(HF)(高达 %)、心肌梗死(MI)(15-25%)。医生-护士-药剂师资源密集型演示 实现和维护BP目标已经显示出有希望的结果，但他们的实际部署被找到了 不可持续的长期。因此，迫切需要一个流程标准化和可持续的解决方案。 解决办法。为了满足这一需求，Optima集成健康中心开发了optima4BP 1.0。这是一辆一流的 人工智能(AI)，模拟治疗医生在临床上进行推理的过程 针对BP靶点优化抗HTN治疗就像医生一样，optima4BP 1.0不能确定 提前完成并维持BP目标1-2年所需的最佳治疗(OT)。护卫 [optima4BP 2.0：实现和维持BP目标的最佳治疗和路线的预测]建议 预先建立个性化的加班费。然后，可以使用OT来选择最短和最安全的治疗 完成和维护BP目标所需的修改路线。第二阶段目标。构建optima4BP 2.0。 第一阶段第一阶段前期工作表明，人工智能模型k近邻可以使用≥进行预测 与医生的决定相比，80%的信心是正确的抗HTN治疗。 第二阶段。Optima4BP 2.0将预测实现和维持BP目标的最佳治疗和路线。 优化处理数据--挖掘源。保护将使用SPRINT(收缩血压 干预试验，2015)和ACCORD(控制糖尿病心血管风险行动，2010)临床试验 数据。它们代表了最当前的抗HTN治疗管理国家指南的基础。 目标1.构建KNN。假设。KNN可以预测患者是否接近最佳状态(临床相关性 治疗(OT)。这是一个里程碑。使≥对医生决策的预测准确率达到90%。第一阶段数据 准备协议将应用于Sprint&Acord数据。然后，KNN合奏学习 将构建函数以选择具有最高证明疗效的最佳治疗方案 在第一阶段开发和测试的3种计算方法中进行选择 目的2.建立最佳治疗路径(OTR)。假设。了解当前和最优 治疗(OT)，可以建立OTR。这是一个里程碑。最安全的途径：实现100%排除导致 在相似的患者群体中发生不良事件。最短路径：实现≥数量减少30% 与内科医生路线相比，治疗方法有所变化。将通过在每个步骤中比较 通过计算的相似性评估确定每个候选治疗方案与OT的相似度。 Optima4BP 2.0旨在建立流程标准化和可持续的解决方案，目标是 减少中风、心力衰竭、心肌梗死和因高血压失控而导致的死亡。