Artificial intelligence can transform the diagnosis of heart disease

In a small room at the Golborne Medical Centre in one of Britain’s poorest areas, doctors and nurses crowded together to test out a brand new stethoscope.

This instrument is similar to those used in clinics, which haven’t been updated for over 200 years. The difference is that this one uses artificial Intelligence in order to detect heart diseases instantly.

In the UK, the first AI stethoscopes have been deployed in primary care at the Golborne practice. It is located just over the railway tracks from London’s affluent Notting Hill neighborhood. Nearly half the patients at Golborne are from non-white minorities, which have a higher mortality rate from heart disease.

Medical regulators have licensed the tool for general practitioners to use. It will be the first AI-based product that can be trusted to prescribe lifesaving medication without a specialist’s review.

AI diagnostics are set to revolutionize the UK National Health Service, and its staff who are under immense pressure. The National Health Service is about to enter what will be its most difficult winter. In October, the figures showed that nearly 7.7 million non-emergency appointment requests were pending.

AI software, if properly designed and thoroughly tested, can provide instant results. It is also cheap to deploy and can be used to triage and prioritise patients on waiting list. The technology’s speed could prevent thousands of unnecessary deaths and offer huge savings to the overburdened healthcare system.

Mihir Kelshiker is an NHS cardiologist at Imperial College London and clinical fellow for digital health. He oversees the deployment of this new tool.

Experts said that the prevalence of heart disease in the UK was likely to be about double the numbers recorded.
The AI stethoscope designed by Mayo Clinic spinoff Eko aims to fill these gaps, and save lives of heart patients that end up in need of emergency hospital care. Kelshiker said, “This is an early treatment method for patients while they are waiting.”

NHS saves £2500 for every patient seen in primary care before an emergency admission. “Scaling this across just one area in north-west London. . . “This will unlock approximately £1mn annually for the system,” said Kelshiker.

Traditional procedures are often flawed. Using stethoscopes, GPs make the initial diagnosis. Symptoms of heart failure such as abdominal bloating and fatigue are common, but they can be missed in routine appointments lasting 10 minutes. This can lead to patients getting very sick.

A blood test is required to confirm the diagnosis of any heart condition. It may also be necessary to refer to a specialist for an electrocardiogram or scan. Both tests must be confirmed before a patient can receive treatment.

The UK currently takes between eight and twelve months on average to see a cardiologist, despite the fact that the diagnosis is supposed to be done within six to eight week.

While they wait for these tests, there are approximately 30,000 deaths in excess per year. Kelshiker said that this is where the bottleneck lies. “People are dying in vain.”

Patrik Bachtiger (a doctor specializing in acute medicine, digital health researcher and NHS doctor) demonstrated the AI stethoscope to Ronald, a recovering heart attack patient, at the Golborne Clinic in November. Bachtiger is Kelshiker’s partner in the project. He placed the mouthpiece of the stethoscope onto Ronald’s chest for 15 second while the algorithms analyzed his heart rhythm. The results were uploaded online immediately.

Yasmin Rasak, a senior GP in the clinic, has been impressed with the tool’s ease of use and speed, as well as the precise measurements that the software makes. She’s already used it to diagnose a patient at home. She said that by using the technology, she was able to reach a larger population of people who might otherwise struggle to get healthcare. There is the potential to screen the entire population, since it’s been brought to primary care.
The blood test is usually completed within a few weeks by the doctor. The drugs are available immediately.

In the past, start-ups had to test, pilot and fund their technology in individual hospitals or NHS trusts. These are the organisations responsible for providing healthcare throughout a region.

Kelshiker said that this can slow down the scaling up process and become an obstacle to the adoption of the technology.

Kelshiker informed the Golborne clinical staff that the AI stethoscope is no longer in a testing phase and does not require any form filling out or consent requests on paper.

He said, “It’s the same thing as giving the patient an ECG with your stethoscope or a physical examination.” We would like you to use it on all adults who come into your practice. The reason is to close the gap in detection for heart disease.

The Eko stethoscope detects three types of heart diseases in 15 seconds: heart failure (which accounts for as much as 4 percent of the NHS budget annually); atrial fibrillation, or irregular heartbeats, which are the leading cause of strokes; and valvular disease.

In clinical studies, the Eko was able detect 85 percent of heart failure that could be treated. The Eko had a 93% specificity for the blood test. This means that patients with AI diagnoses almost always also have abnormal blood tests.

Razak has been using an Eko stethoscope since a few weeks. She said that the AI version is less traditional than the other versions she has used. This might cause older doctors to hesitate. The device also needs to be paired with a mobile phone and charged regularly.

She said that the fact that the tool is being used by GPs “speaks for itself”. She said: “I have seen the excitement surrounding this stethoscope. Everyone sees its value. And the GP practices signing up for it are those that are usually too busy to change, to try out new technology.”

It is a way to reconnect GPs with what they love about primary care and make a meaningful difference to the health of their patients.