Highlights
- •This article describes a study of 965 patients with heart failure who were awaiting cardiac resynchronization therapy.
- •Using natural language processing, a branch of artificial intelligence, we found that clinicians are under documenting assessments and plans pertaining to mental health and substance use.
- •Despite clinical recommendations.
Abstract
Context
Advanced heart failure (HF) patients often experience distressing psychological symptoms,
frequently meeting diagnostic criteria for psychological disorders, including anxiety,
depression, and substance use disorder. Patients with device-based HF therapies have
added risk for psychological disorders, with consequences for their physiological
functioning, including adverse cardiac outcomes.
Objectives
This study used natural language processing (NLP) for computer-assisted chart review
to assess documentation of mental health and substance use in HF patients awaiting
cardiac resynchronization therapy (CRT), a device-based HF therapy.
Methods
We applied NLP to clinical notes from electronic health records (EHR) of 965 consecutive
patients, with 9821 total clinical notes, at two academic medical centers between
2004 and 2015. We developed and validated a keyword library capturing terms related
to mental health and substance use, while balancing specificity and sensitivity.
Results
Mean age was 71.6 years (SD = 11.8), 78% male, and 87% non-Hispanic White. Of the
544 patients (56.4%) with documentation of mental health history, 9.7% had their mental
health assessed and 6.6% had a plan documented. Of the 773 patients (80.1%) with documentation
of substance use history, 10 (1.0%) had an assessment, and 3 (0.3%) had a plan.
Conclusion
Despite clinical recommendations and standards of care, clinicians are under documenting
assessments and plans prior to CRT. Future research should develop an algorithm to
prompt clinicians to document this content. Such quality improvement efforts may ensure
adherence to standards of care and clinical guidelines.
Key Words
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Article info
Publication history
Published online: June 15, 2022
Accepted:
June 9,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
