Machine Intelligence in Cardiovascular Medicine

The computer science technology trend called artificial intelligence (AI) is not new. Both machine learning and deep learning AI applications have recently begun to impact cardiovascular medicine. Scientists working in the AI domain have long recognized the importance of data quality and provenance to AI algorithm efficiency and accuracy. A diverse array of cardiovascular raw data sources of variable quality - electronic medical records, radiological picture archiving and communication systems, laboratory results, omics, etc. - are available to train AI algorithms for predictive modeling of clinical outcomes (in-hospital mortality, acute coronary syndrome risk stratification, etc.), accelerated image interpretation (edge detection, tissue characterization, etc.) and enhanced phenotyping of heterogeneous conditions (heart failure with preserved ejection fraction, hypertension, etc.). A number of software as medical device narrow AI products for cardiac arrhythmia characterization and advanced image deconvolution are now Food and Drug Administration approved, and many others are in the pipeline. Present and future health professionals using AI-infused analytics and wearable devices have 3 critical roles to play in their informed development and ethical application in practice: (1) medical domain experts providing clinical context to computer and data scientists, (2) data stewards assuring the quality, relevance and provenance of data inputs, and (3) real-time and post-hoc interpreters of AI black box solutions and recommendations to patients. The next wave of so-called contextual adaption AI technologies will more closely approximate human decision-making, potentially augmenting cardiologists' real-time performance in emergency rooms, catheterization laboratories, imaging suites, and clinics. However, before such higher order AI technologies are adopted in the clinical setting and by healthcare systems, regulatory agencies, and industry must jointly develop robust AI standards of practice and transparent technology insertion rule sets.