New research has revealed that Black patients are less likely to be underdiagnosed with a common type of heart failure when using AI than during routine care.
The study, funded by the British Heart Foundation (BHF) and King’s College London, used Artificial Intelligence (AI) to understand the extent of Heart Failure with Preserved Ejection Fraction (HFpEF) underdiagnosis across ethnicities, highlighting how algorithms could be used by clinicians to reduce bias and improve diagnoses.
It is estimated that over one million people in the UK have heart failure, and around half1 of these have HFpEF. HFpEF happens when the heart pumps out blood normally, but cannot fill up as well, leading to signs and symptoms of heart failure, such as breathlessness, fatigue and dizziness. This can lead to a decreased quality of life.
The study was co-led by Dr Kevin O’Gallagher, Clinician Scientist and Honorary Consultant in Interventional Cardiology, and Professor Ajay Shah, BHF Chair of Cardiology and Director of the King’s College London BHF Centre of Excellence. The team used an AI algorithm called Natural Language Processing (NLP), that can read and understand medical text and analyse electronic medical records. The AI tool identified nearly 1,973 patients who met the current European Society of Cardiology guidelines2 for a diagnosis of HFpEF. Of these patients, 64 per cent were White, 29 per cent were Black and 7 per cent were Asian3.
The team analysed how the algorithm performed by seeing if these same patients would be effectively diagnosed in routine care without NLP and found that Black and Asian patients were less likely to be underdiagnosed using the AI.
Researchers believe this may be because HFpEF is diagnosed partly by using scores from a test called H2FPEF that is not used in the algorithm. It considers other conditions that could be contributing factors and happens to place a greater emphasis on atrial fibrillation, which was show in this study to be more common in people with White and Asian backgrounds, compared to hypertension which was the more common contributor to risk in Black patients.
Clinicians having to rely on this score as a diagnostic tool may have led to more Black patients being missed. Researchers emphasise the need to improve how we pick up HFpEF, and analyse the ways we can use AI to help bring about more accurate diagnosis.
Dr Kevin O’Gallagher, Clinician Scientist and Honorary Consultant in Interventional Cardiology at King’s College London, said:
“It is vital clinicians are aware of how heart failure presents in patients of all ethnicities if we are to effectively tackle inequalities within the condition.
“More research still needs to be done to improve diagnostic tools. It is crucial that everyone has the same chance of accessing life enhancing treatment when they need it the most.”
Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation and consultant cardiologist said:
“Early diagnosis of HFpEF, is vital in ensuring people get the treatment they need to avoid admission to hospital and live longer lives in good health.
Thanks to new research, there are now evidence-based medicines for HFpEF that can save and improve lives. It more vital than ever that everyone who needs treatment gets it in time and that research studies include large, diverse patient cohorts that are representative of those that are affected by the condition.”
