Aide à la décision médicale et télémédecine dans le suivi de l’insuffisance cardiaque

Abstract : This thesis is part of the "Handle your heart" project aimed at developing a drug prescription assistance device for heart failure patients. In a first part, a study was conducted to highlight the prognostic value of an estimation of plasma volume or its variations for predicting major short-term cardiovascular events. Two classification rules were used, logistic regression and linear discriminant analysis, each preceded by a stepwise variable selection. Three indices to measure the improvement in discrimination ability by adding the biomarker of interest were used. In a second part, in order to identify patients at short-term risk of dying or being hospitalized for progression of heart failure, a short-term event risk score was constructed by an ensemble method, two classification rules, logistic regression and linear discriminant analysis of mixed data, bootstrap samples, and by randomly selecting predictors. We define an event risk measure by an odds-ratio and a measure of the importance of variables and groups of variables using standardized coefficients. We show a property of linear discriminant analysis of mixed data. This methodology for constructing a risk score can be implemented as part of online learning, using stochastic gradient algorithms to update online the predictors. We address the problem of sequential multidimensional linear regression, particularly in the case of a data stream, using a stochastic approximation process. To avoid the phenomenon of numerical explosion which can be encountered and to reduce the computing time in order to take into account a maximum of arriving data, we propose to use a process with online standardized data instead of raw data and to use of several observations per step or all observations until the current step. We define three processes and study their almost sure convergence, one with a variable step-size, an averaged process with a constant step-size, a process with a constant or variable step-size and the use of all observations until the current step without storing them. These processes are compared to classical processes on 11 datasets. The third defined process with constant step-size typically yields the best results
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Kévin Duarte. Aide à la décision médicale et télémédecine dans le suivi de l’insuffisance cardiaque. Statistiques [math.ST]. Université de Lorraine, 2018. Français. ⟨NNT : 2018LORR0283⟩. ⟨tel-02096008⟩

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