{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:45:42Z","timestamp":1790621142460,"version":"4.1.0"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AstraZeneca","award":["D1843R00296"],"award-info":[{"award-number":["D1843R00296"]}]},{"award":["D1843R00296"],"award-info":[{"award-number":["D1843R00296"]}],"id":[{"id":"https:\/\/ror.org\/018nw3344","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Type 2 diabetes mellitus (T2DM) is a multisystemic disease with overlapping metabolic, renal, and cardiovascular effects. Within the Diabetic@ project, which aims to characterize individuals with T2DM using real-world data extracted from electronic health records (EHRs), this substudy sought to develop a predictive model for two-year heart failure (HF) risk. Methods: Multicenter, retrospective study including T2DM individuals across eight Spanish hospitals (2013\u20132018). Data were extracted exclusively from EHRs\u2019 unstructured free text using clinical natural language processing (cNLP) and mapped to SNOMED CT. At inclusion, individuals were categorized as having or not prevalent HF (pHF). Predictive modeling was performed in non-pHF to assess two-year risk of developing HF, termed incident HF (iHF). Logistic regression (LR), decision trees, random forest, and XGBoost were compared, selecting for accuracy and interpretability. Results: Of 588,756 individuals with T2DM, 84,197 (14.3%) had pHF. Among non-pHF, 353,371 (60%) were used for model development (90.7% training, 9.3% validation). iHF occurred in 13.6% of the training set and 11.4% of the validation set. Ischemic heart disease was present in 16.2% overall, 37.9% in pHF, and 12.6% in non-pHF. Glycosylated hemoglobin data was rarely reported (&lt;15%). LR achieved the best performance (AUC-ROC 0.73) using 27 predictors. Reduced 12- and clinically refined 9-predictor models performed similarly, with the latter implemented in a web-based tool. Conclusions: Unstructured data from EHRs enabled development of a two-year HF risk model for individuals with T2DM, underscoring the potential of cNLP for risk stratification across the cardiovascular\u2013renal\u2013metabolic spectrum.<\/jats:p>","DOI":"10.3390\/jcm15093287","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:55:39Z","timestamp":1777370139000},"page":"3287","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Natural Language Processing of Unstructured Healthcare Data for Predicting Heart Failure in Individuals with Type 2 Diabetes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5015-7474","authenticated-orcid":false,"given":"Juan F.","family":"Navarro-Gonz\u00e1lez","sequence":"first","affiliation":[{"name":"Unidad de Investigaci\u00f3n y Servicio de Nefrolog\u00eda, Hospital Universitario Nuestra Se\u00f1ora de Candelaria, 38010 Santa Cruz de Tenerife, Spain"},{"name":"RICORS2040 (RD24\/0004\/0022), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Instituto de Tecnolog\u00edas Biom\u00e9dicas, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain"},{"name":"Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, 35450 Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9706-7783","authenticated-orcid":false,"given":"Leopoldo","family":"P\u00e9rez de Isla","sequence":"additional","affiliation":[{"name":"Servicio de Cardiolog\u00eda, Hospital Cl\u00ednico San Carlos, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"C\u00e1novas Molina","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4748-9777","authenticated-orcid":false,"given":"Miguel \u00c1ngel","family":"Brito-Sanfiel","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4728-2346","authenticated-orcid":false,"given":"David Emilio","family":"Barajas Galindo","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Universitario de Le\u00f3n, 24080 Le\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6935-3056","authenticated-orcid":false,"given":"Luis \u00c1ngel","family":"Cuellar Olmedo","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Universitario R\u00edo Hortega, 47012 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2868-0250","authenticated-orcid":false,"given":"D\u00eddac","family":"Mauricio","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Tof\u00e9 Povedano","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Universitari Son Espases, 07120 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4216-0144","authenticated-orcid":false,"given":"Jos\u00e9 Antonio","family":"Balsa Barro","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Universitario Infanta Sof\u00eda, 28702 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6793-6773","authenticated-orcid":false,"given":"Matilde","family":"Rubio Almanza","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Departamento de Medicina, Hospital Universitari i Polit\u00e8cnic La Fe, 46026 Valencia, Spain"},{"name":"Instituto Investigaci\u00f3n Sanitaria La Fe, Universidad de Valencia, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1755-5518","authenticated-orcid":false,"given":"Jos\u00e9 Juan","family":"Aparicio S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Departamento M\u00e9dico Cardiovascular, Renal y Metabolismo, AstraZeneca Espa\u00f1a, 28050 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miren","family":"Sequera Mutiozabal","sequence":"additional","affiliation":[{"name":"Departamento M\u00e9dico Cardiovascular, Renal y Metabolismo, AstraZeneca Espa\u00f1a, 28050 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4194-9231","authenticated-orcid":false,"given":"Bel\u00e9n","family":"Pimentel","sequence":"additional","affiliation":[{"name":"Departamento M\u00e9dico Cardiovascular, Renal y Metabolismo, AstraZeneca Espa\u00f1a, 28050 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"P\u00e9rez Dom\u00ednguez","sequence":"additional","affiliation":[{"name":"Departamento M\u00e9dico Cardiovascular, Renal y Metabolismo, AstraZeneca Espa\u00f1a, 28050 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3783-8230","authenticated-orcid":false,"given":"V\u00edctor","family":"Latorre Garrido","sequence":"additional","affiliation":[{"name":"Departamento de Estrategia Digital e Innovaci\u00f3n, AstraZeneca Espa\u00f1a, 28050 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Mat\u00e9","sequence":"additional","affiliation":[{"name":"Medsavana S.L., 28004 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Salvador","sequence":"additional","affiliation":[{"name":"Medsavana S.L., 28004 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-4504","authenticated-orcid":false,"given":"Juan Francisco","family":"Merino-Torres","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Departamento de Medicina, Hospital Universitari i Polit\u00e8cnic La Fe, 46026 Valencia, Spain"},{"name":"Instituto Investigaci\u00f3n Sanitaria La Fe, Universidad de Valencia, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5903-430X","authenticated-orcid":false,"given":"Antonio Jes\u00fas","family":"Blanco-Carrasco","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2018). 9. 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