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Evaluation of a Cardiac Diagnostic Program in a Typical Clinical Setting

Affiliations of the authors: Informatics Group, Children's Hospital, Boston, Massachusetts (HSFF); Clinical Decision Making Group, MIT Laboratory for Computer Science, Cambridge, Massachusetts (HSFF, WJL); Division of Cardiology, Tufts-New England Medical Center, Boston, Massachusetts (SN), USA

Correspondence and reprints: Hamish S. F. Fraser, MBCHB, MSc, The Program in Infectious Disease and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115; e-mail: <hamish{at}medg.lcs.mit.edu>.

Received for publication: 07/08/02; accepted for publication: 02/23/03.

Context: The Heart Disease Program (HDP) is a novel computerized diagnosis program incorporating a computer model of cardiovascular physiology. Physicians can enter standard clinical data and receive a differential diagnosis with explanations.

Objective: To evaluate the diagnostic performance of the HDP and its usability by physicians in a typical clinical setting.

Design: A prospective observational study of the HDP in use by physicians in departments of medicine and cardiology of a teaching hospital. Data came from 114 patients with a broad range of cardiac disorders, entered by six physicians.

Measurements: Sensitivity, specificity, and positive predictive value (PPV). Comprehensiveness: the proportion of final diagnoses suggested by the HDP or physicians for each case. Relevance: the proportion of HDP or physicians' diagnoses that are correct. Area under the receiver operating characterist (ROC) curve (AUC) for the HDP and the physicians. Performance was compared with a final diagnosis based on follow-up and further investigations.

Results: Compared with the final diagnoses, the HDP had a higher sensitivity (53.0% vs. 34.8%) and significantly higher comprehensiveness (57.2% vs. 39.5%, p < 0.0001) than the physicians. Physicians' PPV and relevance (56.2%, 56.0%) were higher than the HDP (25.4%, 28.1%). Combining the diagnoses of the physicians and the HDPs, sensitivity was 61.3% and comprehensiveness was 65.7%. These findings were significant in the two collection cohorts and for subanalysis of the most serious diagnoses. The AUCs were similar for the HDP and the physicians.

Conclusions: The heart disease program has the potential to improve the differential diagnoses of physicians in a typical clinical setting.

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