The effectiveness of the algorithm, named CoDE-ACS, was tested on 10,286 patients in six countries around the world, with the results published on 11 May in a research paper in Nature Medicine titled ‘Machine learning for diagnosis of myocardial infarction using cardiac troponin concentrations’. Researchers found that, compared with current testing methods, CoDE-ACS could rule out a heart attack in more than double the number of patients, with 99.6 per cent accuracy. The British Heart Foundation points out that this ability to rule out a heart attack ‘faster than ever before’ could greatly reduce hospital admissions. Clinical trials are now underway in Scotland with support from the Wellcome Leap, to assess whether the tool can help doctors reduce pressure on our overcrowded Emergency Departments. The British Heart Foundation said: “As well as quickly ruling out heart attacks in patients, CoDE-ACS could help doctors to identify those whose abnormal troponin levels were due to a heart attack rather than another condition.”
The AI tool performed well ‘regardless of age, sex, or pre-existing health conditions’, showing its potential for reducing misdiagnosis and inequalities across the population.
“CoDE-ACS has the potential to make emergency care more efficient and effective, by rapidly identifying patients that are safe to go home, and by highlighting to doctors all those that need to stay in hospital for further tests,” the British Heart Foundation said. It explained: “The current gold standard for diagnosing a heart attack is measuring levels of the protein, troponin, in the blood, but the same threshold is used for every patient. This means that factors like age, sex, and other health problems which affect troponin levels are not considered, affecting how accurate heart attack diagnoses are. This can lead to inequalities in diagnosis. For example, previous BHF-funded research has shown that women are 50 per cent more likely to get a wrong initial diagnosis. People who are initially misdiagnosed have a 70 per cent higher risk of dying after 30 days. The new algorithm is an opportunity to prevent this.”
CoDE-ACS was developed using data from 10,038 patients in Scotland who had arrived at hospital with a suspected heart attack. It uses routinely collected patient information, such as age, sex, ECG findings, and medical history, as well as troponin levels, to predict the probability that an individual had had a heart attack. The result is a probability score from 0 to 100 for each patient.
Professor Nicholas Mills, BHF Professor of Cardiology at the Centre for Cardiovascular Science, University of Edinburgh, who led the research, said: “For patients with acute chest pain due to a heart attack, early diagnosis and treatment saves lives. Unfortunately, many conditions cause these common symptoms, and the diagnosis is not always straightforward. Harnessing data and artificial intelligence to support clinical decisions has enormous potential to improve care for patients and efficiency in our busy Emergency Departments.”
Professor Sir Nilesh Samani, British Heart Foundation Medical director, said: “Chest pain is one of the most common reasons that people present to Emergency Departments. Every day, doctors around the world face the challenge of separating patients whose pain is due to a heart attack from those whose pain is due to something less serious. CoDE-ACS, developed using cutting-edge data science and AI, has the potential to rule in or rule out a heart attack more accurately than current approaches. It could be transformational for Emergency Departments, shortening the time needed to make a diagnosis, and much better for patients.”
To view the full research paper here, visit https://www.nature.com/articles/s41591-023-02325-4