Journal Article

Implementation of a national AI technology program on cardiovascular outcomes and the health system

Kemp, Ian, McCann, Gerald P., Rogers, Campbell, Sharma, Sumeet, Rodrigues, Jonathan, O’Kane, Peter, Fairbairn, Timothy A., Bellenger, Nicholas, Weir-McCalL, Jonathan, Venugopal, Vinod, Nicol, Edward, Crooks, Jennifer, Mullen, Sarah, Tidbury, Laurence, Beattie, Anna, Liew, Chee, Carter, Justin, Shaw, Matthew, Hudson, Benjamin, Sehmi, Joban, Mullen, Liam, Motwani, Manish, Deshpande, Aparna, Reid, Anna, Chauhan, Anoop, Parish, Victoria, Iyenger, Sri, Waidyanatha, Sawan, Burnside, Girvan, Bull, Russell, Sunderji, Imran, Greenwood, John P., Schmitt, Matthias, Haworth, Peter, Lip, Gregory Y. H., Beale, Andrew, Watson, Oliver, Mansoubi, Hatef, Duckett, Simon

2025

Overview

Coronary artery disease (CAD) is a major cause of ill health and death worldwide. Coronary computed tomographic angiography (CCTA) is the first-line investigation to detect CAD in symptomatic patients. This diagnostic approach risks greater second-line heart tests and treatments at a cost to the patient and health system. The National Health Service funded use of an artificial intelligence (AI) diagnostic tool, computed tomography (CT)-derived fractional flow reserve (FFR-CT), in patients with chest pain to improve physician decision-making and reduce downstream tests. This observational cohort study assessed the impact of FFR-CT on cardiovascular outcomes by including all patients investigated with CCTA during the national AI implementation program at 27 hospitals (CCTA n = 90,553 and FFR-CT n = 7,863). FFR-CT was safe, with no difference in all-cause ( n = 1,134 (3.2%) versus 1,612 (2.9%), adjusted-hazard ratio (aHR) 1.00 (0.93–1.08), P = 0.97) or cardiovascular mortality ( n = 465 (1.3%) versus 617 (1.1%), aHR 0.96 (0.85–1.08), P = 0.48), while reducing invasive coronary angiograms ( n = 5,720 (16%) versus 8,183 (14.9%), aHR 0.93 (0.90–0.97), P < 0.001) and noninvasive cardiac tests (189/1,000 patients versus 167/1,000), P < 0.001). Implementation of an AI-diagnostic tool as part of a health intervention program was safe and beneficial to the patient pathway and health system with fewer cardiac tests at 2 years. National implementation of a computed tomographic angiography and AI-diagnostic tool, CT-derived fractional flow reserve (FFR-CT), did not provide significant benefits in reducing mortality but led to fewer invasive coronary angiograms and downstream cardiac tests.

• Publisher: Nature Publishing Group US,Nature Publishing Group
• Subject: 692/699/75 / 692/700/1421/1846/2771 / Aged / Angiography / Artificial Intelligence / Biomedical and Life Sciences / Biomedicine / Cancer Research / Cardiovascular disease / Cardiovascular diseases / Cardiovascular Diseases - diagnostic imaging / Computed tomography / Computed Tomography Angiography - methods / Coronary Angiography - methods / Coronary artery disease / Coronary Artery Disease - diagnosis / Coronary Artery Disease - diagnostic imaging / Coronary Artery Disease - mortality / Decision making / Female / Fractional Flow Reserve, Myocardial / Health promotion / Health services / Heart / Humans / Infectious Diseases / Male / Medical imaging / Metabolic Diseases / Middle Aged / Molecular Medicine / Mortality / Neurosciences / Observational studies / Patients