Patients with advanced heart failure (HF) usually exhibit severe psychological symptoms that frequently match diagnostic standards for psychological disorders such as anxiety, sadness, and drug use disorder. The probability of psychological illnesses in patients receiving device-based HF therapy is increased, and these disorders can negatively affect cardiac outcomes and their physiological functioning. For a study, researchers sought to evaluate the documentation of mental health and drug use in HF patients awaiting cardiac resynchronization therapy (CRT), a device-based HF therapy; this study employed natural language processing (NLP) for computer-assisted chart review.
They used NLP to analyze 9,821 total clinical notes from 965 consecutive patients’ electronic health records (EHR) at 2 academic medical facilities between 2004 and 2015. While balancing specificity and sensitivity, they constructed and verified a keyword collection that captures phrases linked to mental health and drug use.
There were 78% men, 87% non-Hispanic Whites, and a mean age of 71.6 years (SD = 11.8). 6.6% of the 544 patients (56.4%) with documented mental health histories had a plan documented, and 9.7% had their mental health assessed. About 10 (1.0%) of the 773 patients (80.1%) who had proof of a history of substance use had an evaluation, and 3 (0.3%) had a plan.
Clinical guidelines and standards of care notwithstanding, physicians were not adequately recording evaluations and plans before CRT. A prompting algorithm for physicians to record the material should be developed in future studies. Such quality improvement initiatives may ensure adherence to clinical guidelines and standards of treatment.