Opportunistic Screening for Asymptomatic Left Ventricular Dysfunction With the Use of Electrocardiographic Artificial Intelligence: A Cost-Effectiveness Approach

Wei-Ting Liu; Ping-Hsuan Hsieh; Chin-Sheng Lin; Wen-Hui Fang; Chih-Hung Wang; Chien-Sung Tsai; Yi-Jen Hung; Chung-Bao Hsieh; Chin Lin; Dung-Jang Tsai

doi:10.1016/j.cjca.2023.11.044

Opportunistic Screening for Asymptomatic Left Ventricular Dysfunction With the Use of Electrocardiographic Artificial Intelligence: A Cost-Effectiveness Approach

Can J Cardiol. 2023 Dec 11:S0828-282X(23)01975-X. doi: 10.1016/j.cjca.2023.11.044. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
² School of Pharmacy, National Denfense Medical Center, Taipei, Taiwan.
³ Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Family and Community Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁴ Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁵ Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁶ Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁷ Division of General Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
⁸ Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan.
⁹ Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Statistics and Information Science, Fu Jen Catholic University, New Taipei City, Taiwan. Electronic address: 157373@mail.fju.edu.tw.

PMID: 38092190
DOI: 10.1016/j.cjca.2023.11.044

Abstract

Background: The burden of asymptomatic left ventricular dysfunction (LVD) is greater than that of heart failure; however, a cost-effective tool for asymptomatic LVD screening has not been well validated. We aimed to prospectively validate an artificial intelligence (AI)-enabled electrocardiography (ECG) algorithm for asymptomatic LVD detection and evaluate its cost-effectiveness for opportunistic screening.

Methods: In this prospective observational study, patients undergoing ECG at outpatient clinics or health check-ups were enrolled in 2 hospitals in Taiwan. Patients were stratified into LVD (left ventricular ejection fraction ≤ 40%) risk groups according to a previously developed ECG algorithm. The performance of AI-ECG was used to conduct a cost-effectiveness analysis of LVD screening compared with no screening. Incremental cost-effectiveness ratio (ICER) and sensitivity analyses were used to examine the cost-effectiveness and robustness of the results.

Results: Among the 29,137 patients, the algorithm demonstrated areas under the receiver operating characteristic curves of 0.984 and 0.945 for detecting LVD within 28 days in the 2 hospital cohorts. For patients not initially scheduled for ECG, the algorithm predicted future echocardiograms (high-risk, 46.2%; medium-risk, 31.4%; low-risk, 14.6%) and LVD (high-risk, 26.2%; medium-risk, 3.4%; low-risk, 0.1%) at 12 months. Opportunistic screening with AI-ECG could result in a negative ICER of -$7,439 for patients aged 65 years, with consistent cost-savings across age groups and particularly in men. Approximately 91.5% of the cases were found to be cost-effective at the willingness-to-pay threshold of $30,000 in the probabilistic analysis.

Conclusions: The use of AI-ECG for asymptomatic LVD risk stratification is promising, and opportunistic screening in outpatient clinics has the potential to reduce costs.