Machine learning algorithms have been widely used to capture the static and temporal patterns within electronic health records (EHRs). While many studies focus on the (primary) prevention of diseases, primordial prevention (preventing the factors that are known to increase the risk of a disease occurring) is still widely under-investigated. In this study, we propose a multi-target regression model leveraging transformers to learn the bidirectional representations of EHR data and predict the future values of 11 major modifiable risk factors of cardiovascular disease (CVD). Inspired by the proven results of pre-training in natural language processing studies, we apply the same principles on EHR data, dividing the training of our model into two phases: pre-training and fine-tuning. We use the fine-tuned transformer model in a "multi-target regression" theme. Following this theme, we combine the 11 disjoint prediction tasks by adding shared and target-specific layers to the model and jointly train the entire model. We evaluate the performance of our proposed method on a large publicly available EHR dataset. Through various experiments, we demonstrate that the proposed method obtains a significant improvement (12.6% MAE on average across all 11 different outputs) over the baselines.
Keywords: cardiovascular disease; electronic health records; multi-target regression; prevention; transformers.