Development and validation of a machine learning risk prediction model for asthma attacks in adults in primary care

Primary care consultations provide an opportunity for patients and clinicians to assess asthma attack risk. Using a data-driven risk prediction tool with routinely collected health records may be an efficient way to aid promotion of effective self-management, and support clinical decision making. Longitudinal Scottish primary care data for 21,250 asthma patients were used to predict the risk of asthma attacks in the following year. A selection of machine learning algorithms (i.e., Naïve Bayes Classifier, Logistic Regression, Random Forests, and Extreme Gradient Boosting), hyperparameters, training data enrichment methods were explored, and validated in a random unseen data partition. Our final Logistic Regression model achieved the best performance when no training data enrichment was applied. Around 1 in 3 (36.2%) predicted high-risk patients had an attack within one year of consultation, compared to approximately 1 in 16 in the predicted low-risk group (6.7%). The model was well calibrated, with a calibration slope of 1.02 and an intercept of 0.004, and the Area under the Curve was 0.75. This model has the potential to increase the efficiency of routine asthma care by creating new personalized care pathways mapped to predicted risk of asthma attacks, such as priority ranking patients for scheduled consultations and interventions. Furthermore, it could be used to educate patients about their individual risk and risk factors, and promote healthier lifestyle changes, use of self-management plans, and early emergency care seeking following rapid symptom deterioration.