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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Tree-based Algorithms for Cardiovascular Disease Prediction</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Mateusz Filipek</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Silesian University Of Technology, Faculty of Applied Mathematics</institution>
          ,
          <addr-line>Kaszubska 23, 44-100 Gliwice</addr-line>
          ,
          <country country="PL">Poland</country>
        </aff>
      </contrib-group>
      <fpage>42</fpage>
      <lpage>51</lpage>
      <abstract>
        <p>One of the issues data scientists run into the most frequently is the classification issue. We can separate the available data into discrete values with the use of classification. Numerous algorithms exist that enable us to solve this issue efectively. This article focuses on tree-based algorithms: Decision Tree Algorithm, and Random Forest Algorithm. The problem that is going to be approached with these algorithms is cardiovascular disease prediction, using the kaggle dataset containing records of patients data [1].</p>
      </abstract>
      <kwd-group>
        <kwd>eol&gt;Decision Trees</kwd>
        <kwd>CART</kwd>
        <kwd>Random Forest</kwd>
        <kwd>Bagging algorithms</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>1. Introduction</title>
      <p>
        These numbers might go even higher in incoming
years. The ongoing COVID pandemic, widespread
lockArtificial intelligence methods [
        <xref ref-type="bibr" rid="ref2 ref3 ref4">2, 3, 4</xref>
        ] play an increas- downs and the increase in people working from home
ingly important role in various types of information can lead to increased numbers of people living
sedensystems. The numerous applications of artificial intelli- tary lifestyles – and these can increase the likelihood of
gence methods are based on several of its most important sufering from heart diseases.
branches. One of the most important are methods based Poor diet, inactivity, dangerous alcohol and tobacco
on fuzzy sets [
        <xref ref-type="bibr" rid="ref5 ref6">5, 6</xref>
        ]. In the papers [
        <xref ref-type="bibr" rid="ref7 ref8 ref9">7, 8, 9</xref>
        ] the authors use - these are just a few examples of lifestyle choices
proposed a system based on the second type fuzzy in- that can increase a person’s chance of developing heart
ference detecting anomalies on the roads. In the work disease. Adult obesity is on the rise, and it’s getting worse
[
        <xref ref-type="bibr" rid="ref10">10</xref>
        ], artificial intelligence methods based on fuzzy sys- than ever. According to the CDC, US obesity prevalence
tems are responsible for the proper airing of rooms. The increased from 30% to roughly 42%. Because
cardiovascusecond very important branch of artificial intelligence lar diseases are responsible for roughly a third of global
algorithms are the [
        <xref ref-type="bibr" rid="ref11 ref12">11, 12</xref>
        ] heuristic algorithms, which deaths, it is of the utmost importance to find a way to
are applicable wherever we strive to minimize or maxi- cure and help people who are sufering from heart
dismize functionals with diferent interpretations resulting eases - but before such diseases can be treated properly,
from the specificity of the issue under consideration. At we need a way to detect them, hopefully long before they
this point, it is worth paying attention to the work on can do great harm.
reducing energy consumption [
        <xref ref-type="bibr" rid="ref13 ref14">13, 14</xref>
        ]. A very important Cardiovascular disease detection is a categorization
group is the third branch of artificial intelligence meth- problem. The results can often be split into two groups:
ods based on neural networks [
        <xref ref-type="bibr" rid="ref15 ref16 ref17 ref18 ref19">15, 16, 17, 18, 19</xref>
        ]. They healthy patients and patients with heart problems. Due
are used in many areas of life, including the detection to the fact that there are only two major result classes
of certain desirable features [
        <xref ref-type="bibr" rid="ref20 ref21">20, 21</xref>
        ], care for the elderly that can be simply defined using a binary system, such as
[
        <xref ref-type="bibr" rid="ref22 ref23">22, 23, 24</xref>
        ], diagnostics [25, 26, 27]. 1 - a sick patient and 0 - a healthy patient, this particular
classification task is known as binary classification.
      </p>
      <sec id="sec-1-1">
        <title>1.1. Cardiovascular Diseases</title>
      </sec>
      <sec id="sec-1-2">
        <title>1.2. Corrado Gini</title>
      </sec>
      <sec id="sec-1-3">
        <title>1.3. Leo Breiman</title>
        <p>American statistician Leo Breiman was born in New
York, USA, in 1928. At the University of California, Leo
Breiman pursued his education. Breiman is primarily
recognized for his work on CART, Bootstrap
Aggregation, which owes its name to him and is now known as
Bagging. Leo Breiman is also the inventor of Random
Forest method.</p>
      </sec>
      <sec id="sec-1-4">
        <title>1.4. Binary Classification</title>
        <p>The CART algorithm builds decision trees utilizing
the Gini’s Impurity Index to create best possible splits of
data.</p>
        <sec id="sec-1-4-1">
          <title>2.1.1. Gini’s Impurity Index</title>
          <p>The Gini’s Ratio is a statistical dispersion metric that
is frequently used to assess income disparity between
countries. Gini’s Impurity is a measure of the likelihood
of choosing a certain feature that is incorrectly classified
in decision trees. If all element in a dataset are of a single
class, then Gini’s Index takes the value of 0, meaning
that that the dataset is pure. Similarly, if all elements of
dataset are of diferent classes, then Gini’s Index takes
the value of 1, which indicates that the dataset is fully
impure. If Gini’s Index is of value 0.5, then the dataset is
shows an equal distribution of elements over available
classes.</p>
          <p>Gini Index can be represented as:</p>
          <p>Gini Index = 1 −

∑︁ ()2,
=1</p>
          <p>Where  represents the probability of each element
being classified for its distinct class.</p>
          <p>In CART decision trees Gini’s Index is used to calculate
the best possible split at each level of the tree.</p>
        </sec>
        <sec id="sec-1-4-2">
          <title>2.1.2. Algorithm</title>
          <p>The process of classifying the components of a set made
up of only two classes is known as binary classification.</p>
          <p>The main applications of binary classification are in
quality control and medical testing to check if a patient is ill
or not, and to assess whether a produced thing fulfills
the specification.</p>
          <p>Some of the most common methods used for solving
the binary classification problems are Decision Trees,
Random Forests and Logistic Regression.</p>
          <p>The Decision Tree Algorithm makes use of a binary tree
data structure, where each node is either a decision node
that is divided based on the best potential Gini Index, or
a terminal node which does not further split, and decide
about the predictions made by the decision tree. Decision
Trees are often described using flowcharts.</p>
          <p>The best possible split is calculated for each node
individually, by checking all the possible values in each
available feature. The pair of value + feature for which
the best Gini’s Index gain was achieved is used for
split2. Proposed Classifiers ting the dataset further into two parts.
Decision Tree is built and read recursively, thanks to
2.1. Decision Tree the underlying data structure. Building the entire tree
for a classifier involves using the training data that has
Decision Trees are among the most commonly used mod- been provided to determine the appropriate splits. It is
els for classification and regression tasks. They can be important to adequately adjust the classifier parameters,
described as a model whose purpose is to ask a dataset a such as maximum depth, or the minimum number of
list of if/else questions, and based on the responses the samples required for performing a split.
decision can be then made. The maximum depth parameter specifies how deep</p>
          <p>Decision Trees are often divided into two categories: the decision tree can get - it is the number of nodes from
classification and regression trees. Regression Trees pro- the root down to the furthest leaf node - the height of
duce numeric output, and classification trees produce underlying tree structure.
categorical output. The latter is the main interest of this Theoretically the maximum depth of the decision tree
article, more specifically the CART implementation of could be almost as high as the number of training samples,
decision trees. however it is not recommended to let the Decision Tree</p>
          <p>Input TR: Training Samples, MaxDepth: Maximum
Depth of the Decision Tree</p>
          <p>Output Decision Tree built based on provided
training samples Building Decision Tree
1: if stopping conditions are met then
2:  a leaf node with adequate class assigned</p>
          <p>to it
3: else
4:  = best possible Gini Gain
5: if  &gt; 0 then
6: recursively build left side of the current node
7: recursively build right side of the current
node
ber of decision trees. Random Forests rely on a lot of
relatively unrelated - thanks to the randomly choosing
of samples - trees, classifying the provided sample using
each one and performing a majority vote to get the best
possible result.</p>
        </sec>
        <sec id="sec-1-4-3">
          <title>2.2.1. Ensemble Algorithms</title>
          <p>The evaluation of the sample provided by ensemble
algorithms typically requires more computing resources than
it would for a single model, but the ’Wisdom of Crowds’
obtained by using multiple models leads to increased
accuracy.
8:</p>
          <p>current node with both sides as- 2.2.2. Bagging
signed to it</p>
          <p>Bagging, also known as bootstrap aggregation, is an
enPredicting sample labels semble learning technique that is used to improve
stabilInput xTest: testing samples ity and accuracy, and to reduce variance within a dataset
Output Predicted labels - decreasing the chance of overfitting models.
Using bagging, Random Forests produce a variety of
1: for do trees by letting each one randomly select a sample from a
2: if currently checked node has a class value as- given dataset. Creating a large number of decision trees
signed to it then helps in reducing overfitting.
3:  assigned class value</p>
        </sec>
        <sec id="sec-1-4-4">
          <title>4: else 2.2.3. Algorithm</title>
          <p>5: if currently tested node has key feature value
greater than checked sample then
6: recursively check left child of node
7: recursively check right side of node
Building a Random Forest
Input Training Samples, Number of trees</p>
          <p>Output Random Forest built based on provided
samples
classifier grow to depth that high, because then it will
overfit.</p>
          <p>Data scientists use the term "overfitting" to indicate
when the results of an analysis fit a set of data too closely.
Such algorithm can perform very well on training data,
but when exposed to an unknown sample, it will attempt
to categorize it using highly specific criteria that may
not be appropriate for classifying the unknown samples.
The depth parameter should not be set too high because
a model that has been trained too precisely on a given
dataset will be fitted to that dataset exactly, which means
it will learn not only how to make decisions based on the
important features and their values but also how to take
into account the existing "noise" - irrelevant information.</p>
          <p>If there is more then a single sample present at a leaf
node, then the outcome is predicted using the Majority
Voting technique, where the class which has the highest
number of representing samples is chosen.</p>
        </sec>
      </sec>
      <sec id="sec-1-5">
        <title>2.2. Random Forest</title>
        <p>Random Forest is an ensemble classification algorithm
that performs classification using a predetermined
num1: for range(Number of trees) do
2: choose random subsample
3: create a Decision Tree using the chosen
subsample
Classifying using Random Forest
Input Test Samples</p>
        <p>Output Classified sample labels
1: for Every test sample do
2: for Every built tree do
3: Classify sample using currently checked
Decision Tree
4: Perform majority voting based on results of
classifying the chosen sample using all decision trees
5:  Classified samples</p>
        <p>Each tree in Random Forest is built using randomly
chosen data from dataset. When predicting the outcome
of provided sample, the sample is provided to every
available tree, and then the results from all the classifications
are subjected to the Majority Voting technique, where the</p>
      </sec>
    </sec>
    <sec id="sec-2">
      <title>3. The Cardiovascular Disease</title>
    </sec>
    <sec id="sec-3">
      <title>Dataset</title>
      <p>The Cardiovascular Disease Dataset consists of 70000
records of patients data, consisting of 11 features each:
1. Age
2. Height
3. Weight
4. Gender
5. Systolic blood pressure
6. Diastolic blood pressure
7. Cholesterol
8. Glucose
9. Smoking
10. Alcohol intake
11. Physical activity</p>
      <sec id="sec-3-1">
        <title>3.1. Data Cleaning</title>
        <p>The process of detecting and fixing even removing,
corrupted, duplicate, or incomplete data is known as data
cleaning.</p>
        <p>In the used dataset there is a number of invalid records,
such as records of patients with systolic blood pressure
that is negative or exceding 16000. Removal of such
records allowed for reducing the total number of samples
by 1413 records.</p>
      </sec>
      <sec id="sec-3-2">
        <title>3.2. Dimensionality reduction</title>
        <p>Dimensionality reduction is the process of minimizing
the number of dimensions - features present in a dataset,
while preserving the greatest amount of variety.
Reducing the number of features accessible can increase
performance, eliminate redundancy, and reduce overfitting.</p>
        <p>Dimensionality reduction works by identifying and
deleting elements that have little to no impact on the
outcomes.</p>
      </sec>
    </sec>
    <sec id="sec-4">
      <title>4. Classification</title>
      <sec id="sec-4-1">
        <title>4.1. Splitting data</title>
        <p>Dataset needs to be split into the training data, and
testing data. Most of the data should be used for training
purposes.</p>
        <p>After a model has been trained using the training set,
it’s accuracy can then be validated using data from testing
set. Because class values in testing set are already known,
the accuracy of classifiers can be correctly calculated.</p>
      </sec>
    </sec>
    <sec id="sec-5">
      <title>5. Classifier Evaluation</title>
      <sec id="sec-5-1">
        <title>5.1. Correctness measures</title>
        <p>5.1.1. P
P is the number of real positive conditions</p>
        <p>N is the number of real negative conditions
5.1.2. N
5.1.3. TP
5.1.4. TN
5.1.5. FP
5.1.6. FN
TP is the number of correctly predicted presence of a
condition.</p>
        <p>TN is the number of correctly predicted absence of a
condition
FP is the number of wrongly predicted presence of a
condition
FN is the number of wrongly predicted absence of a
condition</p>
        <p>These four correctness measure metrics are the
parameters of confusion matrix, they are used to evaluate
specificity, sensitivity and accuracy of classifiers.</p>
        <sec id="sec-5-1-1">
          <title>5.1.7. Accuracy</title>
          <p>The simplest evaluation metric is accuracy. It measures
how accurately projected classes compare to the whole
testing dataset size. The number of labels that were
successfully assigned is known as accuracy.</p>
          <p>ACC =
  +  
 +</p>
        </sec>
        <sec id="sec-5-1-2">
          <title>5.1.8. Precision</title>
          <p>Precision is defined as the ratio of true positives to the
sum of true positives and false positives. Precision
describes how efectively the model predicts the positive
cases out of all the cases it predicts as being true.</p>
          <p>PPV =</p>
          <p>+  
5.1.9. Recall
The proportion of genuine positives to the total of true
positives and false negatives is known as recall. Recall
demonstrates how well the model separates out the
positive cases from all the positive cases in the dataset.</p>
          <p>TPR =</p>
          <p>+  
5.1.10. F1
The harmonic mean of recall and precision is the 1
score.</p>
          <p>*   
*    +</p>
        </sec>
        <sec id="sec-5-1-3">
          <title>5.1.11. Confusion Matrix</title>
          <p>Confusion Matrix is a performance measurement
technique, as the name suggests - it is a matrix, representing
four diferent combinations of predicted and actual
values. Its name comes from the fact that using this matrix
makes it easier to determine whether the model is
incorrectly classifying classes.</p>
          <p>︂(     )︂</p>
          <p />
        </sec>
      </sec>
    </sec>
    <sec id="sec-6">
      <title>6. Testing the Decision Tree</title>
    </sec>
    <sec id="sec-7">
      <title>Classifier</title>
      <sec id="sec-7-1">
        <title>6.0.1. Conclusions</title>
        <p>Single Decision Trees quickly began to overfit, increasing
the maximum depth not only decreased the correctness of
it’s predictions, but also increased the total time needed
for building the tree. The problem of overfitting can be
ifxed by utilizing the bagging technique.</p>
      </sec>
    </sec>
    <sec id="sec-8">
      <title>7. Testing the Random Forest</title>
    </sec>
    <sec id="sec-9">
      <title>Classifier</title>
      <p>The main parameters in Random Forest Classifier that
needs to be adjusted are the total number of trees, as well
as the maximum depth of every single tree.
42–51</p>
      <sec id="sec-9-1">
        <title>7.0.2. Conclusions</title>
        <p>Increasing the total number of trees increased the
correctness of Random Forest classifier. Even with low total
amount of trees Random Forest classifier has better
correctness than a single Decision Tree, bagging helps with
overfitting, the choosing of random samples helps the
classifier to learn the training dataset better.</p>
      </sec>
      <sec id="sec-9-2">
        <title>7.0.3. Testing various maximum depth</title>
        <p>Correctness measured for Random Forest Classifier with
total number of trees equal to 25, and the maximum depth
of trees equal to 2 were:
 = 0.66
   = 0.74
   = 0.64</p>
        <p>Correctness measured for Random Forest Classifier
with total number of trees equal to 25, and the maximum
depth of trees equal to 4 were:
 = 0.67
   = 0.79
   = 0.63
Correctness measured for Random Forest Classifier
with total number of trees equal to 25, and the maximum
depth of trees equal to 16 were:
 = 0.6
   = 0.61
   = 0.59</p>
        <p>Correctness measured for Random Forest Classifier
with total number of trees equal to 25, and the maximum
depth of trees equal to 128 were:
 = 0.62
   = 0.61
   = 0.61</p>
      </sec>
      <sec id="sec-9-3">
        <title>7.0.4. Conclusions</title>
        <p>Changes in the maximum depth of individual trees did
not afect the Random Forest classifier as much as the
total amount of trees.</p>
      </sec>
    </sec>
    <sec id="sec-10">
      <title>8. Conclusions</title>
      <p>The nature of disease prediction problem makes it
suitable to use tree-based algorithms for patient classification.
The proposed algorithms show good correctness. The
presented tests have shown that the proper selection
of classifiers has a great efect on the classification
results. Decision Trees alone can predict reasonably well,
however utilizing bagging algorithms such as Random
Forest can increase the correctness of acquired results,
sacrificing a little execution speed.</p>
    </sec>
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