AI breakthrough challenges the myth that heart disease is a male issue

Heart health experts have welcomed a new AI development which could address the cardiovascular care gap which prevents many women from accessing the life-saving treatment they need.

Scientists have developed a new AI model which is able to better identify female patients at higher risk of heart disease based on an electrocardiogram (ECG). The researchers say the algorithm, designed specifically for female patients, could enable doctors to identify high-risk women earlier, enabling better treatment and care.

The British Heart Foundation, which funded the research, believes it could be a major step forward in improving outcomes for women with heart conditions.

Clinical director of the foundation, Dr Sonya Babu-Narayan, said: “Far too often, women are misdiagnosed or even dismissed by healthcare professionals, thanks to the myth that heart disease is ‘only a male’ issue.

“Even if they do receive the right diagnosis, evidence shows that women are less likely than men to receive recommended treatments.

“This study has applied powerful AI technology to ECGs, a routine, cheap and widely available heart test. Harnessing the potential of this type of research could help better identify those patients at highest risk of future heart problems and reduce the gender gap in heart care outcomes.”

ECGs record the electrical activity of the heart and is one of the most common medical tests in the world. In the new study,  researchers used AI to analyse over one million ECGs from 180,000 patients, of whom 98,000 were female.

They developed a score that measures how closely an individual’s ECG matches ‘typical’ patterns of ECGs for men and women, and which showed a range of risk for each sex.

Women whose ECGs more closely matched the typical ‘male’ pattern – such as having an increased size of the electrical signal – tended to have larger heart chambers and more muscle mass.

Crucially, these women were also found to have a significantly higher risk of cardiovascular disease, future heart failure, and heart attacks, compared to women with ECGs more closely matching the ‘typical female’ ECG.

Previous evidence has shown that men tend to be at higher risk of heart disease – more accurately called cardiovascular disease – which may be due to differences in hormone profiles and lifestyle factors. Because of this, healthcare professionals and the public believe that women’s risk of cardiovascular disease is low.

This is even though the risk for women is also high, with women twice as likely to die of coronary heart disease, the main cause of heart attack, than from breast cancer in the UK.

A recent consensus statement called cardiovascular disease the “number one killer” of women. The statement called for better diagnosis and treatment for women, as well as better female representation in clinical trials.

Study leader Dr Arunashis Sau, of Imperial College Healthcare NHS Trust, said: “Our work has underlined that cardiovascular disease in females is far more complex than previously thought.

“In the clinic we use tests like ECGs to provide a snapshot of what’s going on but as a result this may involve grouping patients by sex in a way that doesn’t take into account their individual physiology.

“The AI enhanced ECGs give us a more nuanced understanding of female heart health – and we believe this could be used to improve outcomes for women at risk of heart disease.”

Senior author Dr Fu Siong Ng, of Imperial College Healthcare NHS Trust and Chelsea and Westminster Hospital NHS Foundation Trust, added: “Many of the women identified were in fact at even higher risk than the ‘average’ man. If it becomes used widely, over time the AI model may reduce gender differences in cardiac care, and improve outcomes for women at risk of heart disease.”

The research group recently published another paper on the related AI-ECG risk estimation model, known as AIRE, which can predict patients’ risk of developing and worsening disease from an ECG. Trials of AIRE in the NHS are already planned for late 2025.

These will evaluate the benefits of implementing the model with real patients from hospitals across Imperial College Healthcare NHS Trust and Chelsea and Westminster Hospital NHS Foundation Trust. This model will be trialled in conjunction with AIRE.