Automatic triage of twelve-lead electrocardiograms using deep convolutional neural networks: a first implementation study

Rutger R. van de Leur, Meike T.G.M. van Sleuwen, Peter Paul M. Zwetsloot, Pim van der Harst, Pieter A. Doevendans, Rutger J. Hassink, René van Es*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Aims Expert knowledge to correctly interpret electrocardiograms (ECGs) is not always readily available. An artificial intelligence (AI)-based triage algorithm (DELTAnet), able to support physicians in ECG prioritization, could help reduce current logistic burden of overreading ECGs and improve time to treatment for acute and life-threatening disorders. However, the effect of clinical implementation of such AI algorithms is rarely investigated. Methods Adult patients at non-cardiology departments who underwent ECG testing as a part of routine clinical care were included in and results this prospective cohort study. DELTAnet was used to classify 12-lead ECGs into one of the following triage classes: normal, abnormal not acute, subacute, and acute. Performance was compared with triage classes based on the final clinical diagnosis. Moreover, the associations between predicted classes and clinical outcomes were investigated. A total of 1061 patients and ECGs were included. Performance was good with a mean concordance statistic of 0.96 (95% confidence interval 0.95–0.97) when comparing DELTAnet with the clinical triage classes. Moreover, zero ECGs that required a change in policy or referral to the cardiologist were missed and there was a limited number of cases predicted as acute that did not require follow-up (2.6%). Conclusion This study is the first to prospectively investigate the impact of clinical implementation of an ECG-based AI triage algorithm. It shows that DELTAnet is efficacious and safe to be used in clinical practice for triage of 12-lead ECGs in non-cardiology hospital departments.

Original languageEnglish
Pages (from-to)89-96
Number of pages8
JournalEuropean Heart Journal - Digital Health
Volume5
Issue number1
DOIs
Publication statusPublished - 1 Jan 2024

Keywords

  • Deep learning
  • Electrocardiography
  • Implementation
  • Triage

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