Artificial intelligence for direct-to-physician reporting of ambulatory electrocardiography.

Journal: Nature medicine
PMID:

Abstract

Developments in ambulatory electrocardiogram (ECG) technology have led to vast amounts of ECG data that currently need to be interpreted by human technicians. Here we tested an artificial intelligence (AI) algorithm for direct-to-physician reporting of ambulatory ECGs. Beat-by-beat annotation of 14,606 individual ambulatory ECG recordings (mean duration = 14 ± 10 days) was performed by certified ECG technicians (n = 167) and an ensemble AI model, called DeepRhythmAI. To compare the performance of the AI model and the technicians, a random sample of 5,235 rhythm events identified by the AI model or by technicians, of which 2,236 events were identified as critical arrhythmias, was selected for annotation by one of 17 cardiologist consensus panels. The mean sensitivity of the AI model for the identification of critical arrhythmias was 98.6% (95% confidence interval (CI) = 97.7-99.4), as compared to 80.3% (95% CI = 77.3-83.3%) for the technicians. False-negative findings were observed in 3.2/1,000 patients for the AI model versus 44.3/1,000 patients for the technicians. Accordingly, the relative risk of a missed diagnosis was 14.1 (95% CI = 10.4-19.0) times higher for the technicians. However, a higher false-positive event rate was observed for the AI model (12 (interquartile range (IQR) = 6-74)/1,000 patient days) as compared to the technicians (5 (IQR = 2-153)/1,000 patient days). We conclude that the DeepRhythmAI model has excellent negative predictive value for critical arrhythmias, substantially reducing false-negative findings, but at a modest cost of increased false-positive findings. AI-only analysis to facilitate direct-to-physician reporting could potentially reduce costs and improve access to care and outcomes in patients who need ambulatory ECG monitoring.

Authors

  • L S Johnson
    Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden. linda.johnson@med.lu.se.
  • P Zadrozniak
    Medicalgorithmics S.A., Warsaw, Poland.
  • G Jasina
    Medicalgorithmics S.A., Warsaw, Poland.
  • A Grotek-Cuprjak
    Medicalgorithmics S.A., Warsaw, Poland.
  • J G Andrade
    Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
  • E Svennberg
    Karolinska Institutet, Stockholm, Sweden.
  • S Z Diederichsen
    Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
  • W F McIntyre
    Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
  • S Stavrakis
    University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
  • J Benezet-Mazuecos
    Cardiology Department Hospital Universitario La Luz, Madrid, Spain.
  • P Krisai
    Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Z Iakobishvili
    Department of Cardiology, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel.
  • A Laish-Farkash
    Department of Cardiology, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel.
  • S Bhavnani
    Division of Cardiology, Scripps Clinic, San Diego, CA, USA.
  • E Ljungström
    Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden.
  • J Bacevicius
    Clinic of Heart and Vessel Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
  • N L van Vreeswijk
    Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
  • M Rienstra
    Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
  • R Spittler
    Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.
  • J A Marx
    Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.
  • A Oraii
    Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
  • A Miracle Blanco
    Cardiology Department Hospital Universitario La Luz, Madrid, Spain.
  • A Lozano
    Cardiology Department Hospital Universitario La Luz, Madrid, Spain.
  • I Mustafina
    University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
  • S Zafeiropoulos
    Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, USA.
  • R Bennett
    Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
  • J Bisson
    Department of Cardiology, Centre hospitalier de l'Université de Montréal-Université de Montréal, Montréal, Quebec, Canada.
  • D Linz
    Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
  • Y Kogan
    Department of Cardiology, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel.
  • E Glazer
    Department of Cardiology, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel.
  • G Marincheva
    Department of Cardiology, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel.
  • M Rahkovich
    Department of Cardiology, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel.
  • E Shaked
    Department of Cardiology, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel.
  • M H Ruwald
    Department of Cardiology, Gentofte Hospital, Hellerup, Denmark.
  • K Haugan
    Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
  • J Węcławski
    Medicalgorithmics S.A., Warsaw, Poland.
  • G Radoslovich
    Hackensack University Medical Center, Hackensack, NJ, USA.
  • S Jamal
    Hackensack University Medical Center, Hackensack, NJ, USA.
  • A Brandes
    Department of Cardiology, Esbjerg Hospital-University Hospital of Southern Denmark, Esbjerg, Denmark.
  • P T Matusik
    Department of Electrocardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
  • M Manninger
    Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria.
  • P B Meyre
    Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
  • S Blum
    Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
  • A Persson
    Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
  • A Måneheim
    Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
  • P Hammarlund
    Department of Cardiology, Helsingborg Hospital, Helsingborg, Sweden.
  • A Fedorowski
    Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
  • T Wodaje
    Karolinska Institutet, Stockholm, Sweden.
  • C Lewinter
    Karolinska Institutet, Stockholm, Sweden.
  • V Juknevicius
    Clinic of Heart and Vessel Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
  • R Jakaite
    Clinic of Heart and Vessel Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
  • C Shen
    Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
  • T Glotzer
    Hackensack University Medical Center, Hackensack, NJ, USA.
  • P Platonov
    Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden.
  • G Engström
    Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
  • A P Benz
    Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
  • J S Healey
    Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.