Medical Engineering and Physics 105 (2022) 103825

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Medical Engineering and Physics

journal homepage: www.elsevier.com/locate/medengphy

A systematic review on machine learning approaches for cardiovascular

disease prediction using medical big data
Javed Azmi a, Muhammad Arif b, *, Md Tabrez Nafis a, M. Afshar Alam a, Safdar Tanweer a,
Guojun Wang b
a
Department of Computer Science & Engineering, Jamia Hamdard, New Delhi, India
b
School of Computer Science and Cyber Engineering, Guangzhou University, Guangzhou 510006, China

A R T I C L E I N F O A B S T R A C T

Keywords: There is a considerable rise in cardiovascular diseases in the world. It is pertinently essential to make cardio­
Cardiovascular disease vascular prediction accurate to the maximum. A forecast based on machine learning techniques can be beneficial
CVD in detecting cardiovascular disease (CVD) with maximum precision and accuracy. The disease’s effective pre­
Classification
diction helps in early diagnosis, which cuts down the mortality rate. A health history and the causes of heart
Machine learning
disease require the efficient detection and prediction of CVD. Data analytics is beneficial for making predictions
Disease prediction
based on a massive amount of data, and it aids health clinics in disease prognosis. Regularly, a large volume of
patient-related data is maintained. The information gathered can be used to forecast the emergence of upcoming
diseases. Our study presents a detailed comparative study of Cardiovascular Disease by comparing the various
machine learning techniques mainly comprising of classification and predictive algorithms. The study shows an
in-depth analysis of around forty-one papers related to cardiovascular disease by using machine learning tech­
niques. This study evaluates the selected publications rigorously and identifies gaps in the available literature,
making it useful for researchers to develop and apply in clinical fields, primarily on datasets related to heart
disease. The current study will aid medical practitioners in predicting heart threats ahead of time, allowing them
to take preventative measures.

1. Introduction high-quality data necessitates the optimization of data gathering tools in

People have a routine and a hectic schedule in their daily lives, which
causes tension and worry. Also, the percentage of cigarette-addicted and
obese individuals has increased dramatically, causing diseases such as
cancer, heart problems, and other conditions [1]. The most challenging
aspect of these diseases is predicting them. Each individual’s blood
pressure (BP) and heart rate vary, but the pulse rate of the average in­
dividual ranges from 60 to 100 beats/minute, and the intermediate BP
level could be around 120/80. Any obstruction or anomaly in the heart’s
average blood circulation or flow might result in a variety of serious
heart disease consequences. These disorders, often known as cardio­
vascular diseases, are among the worst. Heart disorders, blood vessel
diseases, and vascular diseases of the brain are all examples of cardio­
vascular diseases [2].
Big data enables healthcare providers and administrators to delve
deeper into their patients’ histories and the care they give. Collecting
health care, as well as their proper utilisation by both patients and
doctors. Electronic health records (EHRs), medical imaging, genetic
sequencing, payor records, pharmaceutical research, wearables, and
medical gadgets, to name a few, are all examples of big data in health­
care. It differs from standard computerised medical and human health
data used for decision-making in three ways: It’s widely available; it
moves quickly and covers the vast digital universe of the health sector;
and, because it’s derived from a variety of sources, it’s very varied in
structure and character.
Cardiovascular disease (CVD) is one of the most severe disorders in
the world. Medical evidence has indicated that some health conditions
enhance a person’s probability of developing cardiovascular disease,
notably heart disease. A few of these risks are a family history of CVDs,
hypertension, low HDL (good) cholesterol, high LDL (bad) cholesterol, a
high-fat diet, and lack of regular exercise [3]. As a person grows older,
the probability of developing heart disease increases. It is more common

* Corresponding author.
E-mail address: arifmuhammad36@hotmail.com (M. Arif).

https://doi.org/10.1016/j.medengphy.2022.103825
Received 7 February 2022; Received in revised form 4 May 2022; Accepted 26 May 2022
Available online 27 May 2022
1350-4533/© 2022 IPEM. Published by Elsevier Ltd. All rights reserved.
J. Azmi et al.
in men, whereas women, on the other hand, are at risk after menopause.
A stressful lifestyle can degrade arteries and raise the risk of developing
heart disease. Physicians diagnose based on these and other character­
istics and past diagnoses made on patients in similar situations. Millions
of cases have increased in the last several years, and many have died
from heart problems. As per a WHO report, CVD is responsible for 17.9
million deaths around the world [4]. The heart is a vital organ and plays
an essential role in the human body. If there is any problem with it has a
significant impact on one’s health. CVD symptoms such as hypertension,
high BP, chest pain, cardiac arrest, etc., are used for diagnosis. There are
various forms of heart problems, each with its own set of symptoms. The
rising risk of CVD has become a worldwide issue. As a result, the health
sector must define and improve ways to lessen the socioeconomic effect
of chronic disorders. In the healthcare industry, a vast amount of data on
heart disease is available, which may be analyzed to make informed
decisions. Machine learning and data mining techniques are heavily
used in medical data analysis and knowledge extraction. Researchers
have been urged to perform numerous studies in order to reduce sickness
and mortality rates associated with cardiovascular diseases around the
world [5].
Machine learning (ML) is widely suggested for heart disease pre­
diction since it extracts more efficient and accurate data from massive
datasets, making prediction simple. It is the primary basis of machine
learning that aids in managing vast amounts of data, has high processing
speed, and generates predictions in the early stages of development. ML
applications prevent hospital errors and improve health policy, disease
prevention, early detection, and avoidable hospital fatalities. Numerous
studies have done similar work, namely determining which ML ap­
proaches could diagnose cardiac disease [6,7].
Although machine learning can enhance heart attack prediction
outcomes, more studies can improve the prognosis and simplification of
ML algorithms. These research articles have been published from 2018
to 2021; however, twelve in 2021, ten in 2020 and 2019, and nine in
2018 using ML algorithms on cardiac disease datasets. Different ma­
chine learning approaches, like classification, prediction, and pattern
recognition, can predict cardiovascular problems. In this survey, ma­
chine learning-based classification algorithms such as Decision Tree,
Support Vector Machine, Random Forest, Naive Bayes, Artificial Neural
Network, K-Nearest Neighbor, and Linear Regressionuse to identify
heart disorders. We’ve tried to examine many of the problems and issues
that influence the heart and lead to CVD and discuss several methods for
predicting heart disease. The remainder of the article organize as fol­
lows: Section 2 discusses the use of machine learning methods for
ailment prediction, section 3 illustrates the work of different researchers
for evaluation of the methods used in ML-based CVD prediction, section
4 highlight the gaps of ML model discussed in the literature whether a
model is a traditional or hybrid model has some drawback, section 5 give
the concept of a general framework for CVD classification, section 6
provides discussion and analysis of machine learning algorithm perfor­
mance in CVD prediction, and section 7 present the conclusion of the
studyof CVD prediction.
2. Machine learning (ML)
Arthur Samuel gave the term "Machine Learning" in 1959, defining it
as a field that allows computers to learn without having to be explicitly
taught [8]. The process involves creating algorithms based on previous
data and experience and is known as machine learning. Tom Mitchell in
1997 defined ML as, "A computer program is said to learn from expe­
rience E with respect to some class of tasks T and performance measure
P, if its performance at tasks in T, as measured by P, improves with
experience E” [9].
Machine Learning is a branch of artificial intelligence that allows a
system to learn from data rather than explicit programming. ML is a
complex process that uses a range of algorithms to enhance, explain, and
predict outcomes by continuous learning from data [10]. It is feasible to
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Medical Engineering and Physics 105 (2022) 103825
generate increasingly accurate predictions based on training data as the
algorithms absorb it. Computational approaches that use the experience
to improve performance or create accurate predictions can describe as
machine learning. Experience is the last data present to the patient,
collected in electronic health data and accessible for diagnosis [11]. The
data can computerize user training sets or other data records collected
through environmental interactions. In all circumstances, the success of
a learner’s prediction relies on the quality and sufficient size of the data.
Designing accurate and precise prediction techniques is an essential
function of machine learning. The space and time complexity of these
algorithms, like in other fields of computer science, are important in­
dicators of their excellence. However, sample complexity is essential in
machine learning to analyze the collected data needed for the technique
to learn a pattern of notions. The complexity of the notion classes
assessing and the volume of the training dataset determine independent
learning possibilities for an algorithm.
Fig. 1 is the ML model results from training an algorithm with data
and then providing it with test data to get a prediction outcome. A
predictive approach is a model that provides a prediction based on
trained data [12]. As a result, ML is critical for developing analytics
models. Applications of machine learning can be used in the accurate
diagnosis, prescribing medicines, and different sorts of pathological tests
and the early symptom of diseases and, at a later stage, the right kinds of
opinion-making. Medical diagnosis is a significant aspect of things as it
decides the line of treatment better. That is why the utilization of
techniques is widely using machine learning [13]. Thus, machine
learning is very crucial for the fast and accurate line of treatments.
Applying the computer-based decision support system can assume a
significant job, incorrect diagnosis, and financially savvy treatments.
Machine learning aims to create progressively positive results for ac­
curate forecasts. Thus, it seems that machine learning is very effective in
classifying diseases in a better way. Machine learning applications have
been seen in numerous fields, such as healthcare, social data, social
media, retail, traffic control, self-driving car, speech recognition, image
recognition, medical diagnosis, etc.
3. Classification of ML techniques
Machine learning is an area of AI that includes the development of
algorithms to consequently study through algorithm performance and
experience to be enhanced with every understanding. The algorithm
recognizes some prototypes in input information and structure-based
models dependent on input information to build forecasts for new re­
ports [14]. A machine learning technique intensely depends on pro­
cessing power. Building algorithms fit for doing this utilizes the binary
’yes’ and ’no’ are the logic of the computers and is the establishment of
machine learning. Fig. 2 presents the various kinds of ML classifications
and their techniques:
The machine learning techniques depend on distinguishing designs
and patterns from the vast data collections that offer help for expecta­
tions and assessment processes for diagnosis and treatment plans. Ma­
chine learning predicts the output of healthcare data precisely by
applying various algorithms such as supervised, unsupervised and
Fig. 1. Concept of machine learning.
J. Azmi et al.
Fig. 2. Classification of Machine Learning techniques.
reinforcement, etc., for analysis. The classifications of machine learning
techniques are as follows:
3.1. Supervised learning techniques
It includes a training set on the labelled data and utilizes it to expect
the new information. It contains the splitting of data between the
training and testing sets. The training set first trains the group, and then
the exhibition is tried on the testing set. The presentation of the set can
be classified using regression measurements. A marked assessment of
supervised learning is divided into two groups, such as classification or
regression problems. However, on the other hand, the sets are utilized to
foresee the result, which depends on numerical data information in
supervised learning [15].
While classifying the primary information data, the data is initially
chosen, subsequently afterwards before performing processing per­
formed, and evaluate all the missing values (NA). At that point, data
standardize utilizing min-max standardization or z-score. Then, the
standardization is applied to choose the best highlights, including a
choice strategy. Once the highlight is selected, a few supervised machine
learning algorithms incorporate things like DT, RB, LR, NB, SVM, KNN,
and ANN classifier is provided for classification of raw data as
mentioned below:
3.1.1. Decision tree (DT)
DT is similar to a tree-like structure for predictive models and its
applications spreading over various fields. It can build utilizing an al­
gorithm methodology that distinguishes approaches to divide the in­
formation support in different situations. The tree is one of the most
broadly used and down-to-earth strategies for supervised technique
learning. It is a non-parametric supervised technique utilized in classi­
fication and regression [16]. Fig. 3 describes the algorithm that uses the
most significant predictor divides the groupings into two or more related
subsets. The Decision Tree method begins by calculating the entropy of
all attributes. The dataset divides into the highest score and lowest en­
tropy using predictors or variables, and these operations repeat with the
Fig. 3. Decision tree.
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Medical Engineering and Physics 105 (2022) 103825
remaining features [17].
3.1.2. Support vector machines (SVM)
SVM is the latest supervised ML technique introduced by Vapnik in
the year 1995 [18]. It reduces experimental accuracy arrangement and
amplifies the geometrical edge among these classes. The SVM algorithm
is a widely used supervised machine learning technique with a pre­
defined attribute value that can utilize both a classifier and a predictor.
In the feature space, SVM locates the hyper-plane, which distinguishes
among the classes for classification. The SVM algorithm depicts in the
feature space plots the coordinates of trained data so that a broad range
separates values belonging to different categories. The fall of test data
values on which side of the margin base is planned into the space and
then categorized [19].
Fig. 4 helped to build the SVM and the data points nearer to the
hyperplane are called support vectors that affect its orientation and
position. We maximize the classifier’s margin by using these support
vectors, and if the support vectors remove, it will alter the part of the
hyper-plane.
3.1.3. Random forest (RF)
Random Forest is a well-known and effective ML technique. This
algorithm works efficiently for both classification and regression, but it
excels at classification [20]. Bagging Aggregation or Bootstrap Aggre­
gation is a type of ML algorithm. The bootstrap method is a strong sta­
tistical strategy for approximate values from sample data, such as the
mean. A large number of data samples obtains to calculate the mean
[21]. Finally, the average of all the mean values calculates to estimate
the actual average value. Bagging employs the same procedure, but
rather than calculating the mean value of each sample data, DT has
widely used it. The number of data samples considered for the training
and generates the training models for every data sample. Each model
gives a prediction when any data prediction is needed, and these pre­
dictions provide an average to better assess the actual output value [22].
Fig. 5 is based on ensemble learning essentially means that many
Fig. 4. Support vector machine.
J. Azmi et al. Medical Engineering and Physics 105 (2022) 103825

Fig. 5. Random forest.

classifiers are combined to improve performance. It is a collection of
decision trees that use most of the decision trees’ output to enhance
prediction and outcome metrics.
3.1.4. Naive Bayes (NB)
The term "Naive Bayes Classifier" refers to a supervised learning
classification model based on the Bayes Theorem and substantial inde­
pendence requirements [23]. It assumes that the presence or absence of
a specific feature of a class has no bearing on the presence or absence of
any other element. Conditional probabilities underpin the NB algorithm.
It employs Bayes’ theorem, which computes a probability by calculating
historical data value frequency and combinations. This theorem calcu­
lates the likelihood of an event occurring, given the chance of another
event happening and based on the Bayes theorem, NB is a basic but
powerful categorization algorithm [24]. Fig. 6 implies predictor inde­
pendence, which means that the traits or features should not be asso­
ciated with one another or related in any manner. It is naive because, in
the case of dependency, all characteristics or attributes improve the
probability freely.
( ) ( )
A P B ∗ P (A)
P = A
B P(B)
regression are similar in terms of calculating the coefficient values inside
their attribute values. Here, the logistic function constructs output
prediction using a non-linear function, which is not identical to linear
regression. Its attributes values lie in the range from 0 to 1. The logistic
regression predictions use to evaluate the probability of class 0 or class 1
for data instances, which can be helpful in cases where an additional
explanation for a prediction is required. When features associated with
one another and features indifferent to output variables remove, then
logistic regression performs better [26].
Fig. 7 illustrates the linear relationship between the independent (X)
and dependent (Y) variables and independent variable X is directly
proportional to the dependent variable Y. Based on the data points
provided, and we attempt to construct a line that best fits the straight-
line model for the points.
3.1.6. Artificial neural networks (ANN)
Artificial neural networks, also termed Multilayer Perceptron (MLP),
are inspired by the biological and capable of simulating exceedingly
complicated non-linear functions. ANN is an essential tool of machine
learning. The term neural in artificial neural networks implies that they

Where,
P(A): Hypothesis H is true for probability and is term as the prior
probability.
P(B): Evidence-based probability.
( )
P AB : Hypothesis true for evidence-based probability.
( B)
P A : Evidence is true for hypothesis-based probability.

3.1.5. Logistic regression (LR)

Logistic regression is an ML algorithm derived from the discipline of
statistics. This technique is helpful for binary classification, in which
values are classified into two groups [25]. Logistic regression and linear Fig. 7. Logistic regression.

Fig. 6. Naïve Bayes.

4
J. Azmi et al.
are cognition systems designed to replicate how learning occurs [27].
There are three layers in the neural networks: input, hidden, and output
layers. The hidden layer has made up of units that turn the input into a
pattern that the output layer may control. ANNs are great tools for
extracting and instructing the computer to recognize patterns that are
too complex or unclear for users to identify [28]. Neural networks have
been in use since the 1940s. In recent decades they have become a sig­
nificant aspect of artificial intelligence due to introducing a new
approach known as backpropagation. It enables networks to alter their
hidden layers of neurons in circumstances where the outputs do not
match the user’s expectations. The link between the layers depicts in
Fig. 8:
Fig. 8 shows that the input layer is the ANN’s first layer and has made
up of neurons that transmit data to the hidden layer and then to the
output layer, which comprises the weight, cost, and activation functions,
for further processing.
3.1.7. K-Nearest neighbor (KNN)
Hodges et al. in 1951 established the KNN rule as a non-parametric
pattern classification tool [29]. One of the most basic but highly effi­
cient categorization strategies is the KNN technique. It has no data as­
sumptions and is typically used for classification problems without
understanding the data distribution. This approach comprises locating
the k nearest data points in the training dataset to the point for which a
target value is missing and applying the approximate value of the
identified data sets to it [30].
Fig. 9 illustrates the data point is categorized by its nearest neigh­
bors, then by the majority vote of those neighbors; a query point is
assigned to the data class with the most representatives among the
point’s nearest neighbors.
4. Literature review
Only state-of-the-art studies and approaches are present to ensure the
survey’s quality, and research articles from 2018 to the present have
been chosen for the study. A total of 41 research articles consider at the
end of the selection process. After analyzing the selected publications,
the key findings are discussed in this section. It gives a synopsis of the
approaches presented in the selected papers. The research papers were
divided into categories using machine learning algorithms and utilizing
their methodologies on CVD datasets were chosen for this survey
investigation. The approaches listed below are the most commonly used
to classify cardiac failure and cardiac disease.
4.1. Random forest
Nissa et al. =[31] compares different machine learning systems for
CVD prediction in its initial stages. The dataset’s quality was increased
by adopting pre-processing techniques, with the primary focus being on
observing the data and dealing with incorrect and missing values. In
addition, the researcher used the three supervised ML algorithms to
predict the condition, and their results compared with using various
evaluation metrics. The dataset collects from the UCI repository. Two
Fig. 8. Artificial neural networks.
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Medical Engineering and Physics 105 (2022) 103825
Fig. 9. K-Nearest neighbor.
datasets obtain, one with 303 occurrences and 14 features and 1026
occurrences and 14 features. When the datasets are combined, the final
dataset has 1329 instances and 14 features. The experimental results,
the dataset with accuracy of 100% for the training and 97.29% for the
testing set, is the highest among all classifiers. The reliability of SVM,
DT, and RF assessment using a 10-fold cross-validation technique. With
an accuracy of 99.39%, RF leads the other algorithms, followed by a DT
with 99.59% accuracy.
Annu Dhankhar [32] seek to identify the best algorithm to predict
HD utilizing several ML techniques from the UCI Repository of heart
disease datasets. In the HD prediction, the whole dataset divides into
two sets, 80% training data and 20% testing data, to analyze the accu­
racy of the classification model. The obtained data were analyzed using
KNN, RF, DT, and SVM algorithms, and that RF is the best classification
model with a 90% accuracy.
Ghosh et al. (2021) [33] develops an efficient model for Coronary
Heart Disease prediction, using ML classifications such as DT, RF, KNN,
AdaBoost, Gradient Boosting, as well as hybrid classifiers. Relief and
LASSO are different evaluation approaches used to determine the most
critical attributes from medical references based on rank values. The five
datasets are Cleveland, VA Long Beach, Switzerland, Hungary, and
Statlog from the UCI repository collect and to create a larger and more
trustworthy dataset. The researcher also deals with machine learning’s
over-fitting and under-fitting issues. In addition, several hybrid ap­
proaches, such as Boosting, and Bagging uses to increase the testing rate
while decreasing the performance time. The Random Forest with
Bagging model (RFBM) is 99.05% accurate.
Maini et al. [34] proposed an efficient and cost-effective prediction
approach for CVD early detection. A tertiary hospital in South India
provided a total of 1670 categorized health records. 70% of the obtained
data uses to train the predictive model. The prediction system utilizes
Python and five cutting-edge ML algorithms NB, KNN, RF, AdaBoost,
and LR. The best prediction method is the RF, which successfully iden­
tified 470 out of 501 medical data points, yielding an accuracy rate of
93.8%.
Mishra et al. [35] proposed that the system analyses the symptoms
reported by the user input data and predicts the occurrence of the dis­
ease as an output. Disease prediction accomplishes by using six algo­
rithm techniques: SVM, KNN, RF, LR, DT, and ANN with one hidden
layer. This project also provides insight into EDA. Furthermore, the web
platform predicts the user’s health risk and offers relevant recommen­
dations based on their health status. The UCI repository dataset was
used, and consider 13 attributes, which give the core basis for tests and
provide accurate findings. Even without restructuring, this system
functions admirably. This research could react to concerns about the
model’s simplicity of explanation. Moreover, with random forest with
accuracy rate of 93.60%, forecast is entirely accurate and feasible.
Padmaja et al. [36] employs ML techniques to develop a model for
early prediction of cardiac illness, which will benefit doctors in recog­
nizing the condition. Classification techniques use input data to predict
and categorize it into the appropriate category or class. DT, LR, KNN, RF,
SVM, NB, and Gradient Boosting are some classification algorithms.
These ML algorithms train to predict the incidence of CVD. Their
J. Azmi et al.
performance is compared to evaluation metrics such as accuracy,
sensitivity, and precision to determine the best classification model for
predicting HD instances. The UCI repository of the Cleveland dataset
uses for trainingand testing, which considers age, gender, chest
discomfort, resting blood pressure, resting ECG, maximum heart rate
and produces an output indicating whether or not the person has the
cardiac infection. The usage of feature selection methods contributes to
the model’s accuracy. The random forest classifier achieved an accuracy
of 93.44%.
Kavitha et al. [37] developed a hybrid model that produces effective
outcomes using a ML technique, which recognize in the applications.
The probabilities obtained from one machine learning technique input
the other ML technique in a hybrid model. The Cleveland dataset from
the UCI repository is used for analysis, and there are 303 cases with 14
different features. CVD prediction using ML algorithm such as RF and
DT. The use of the hybrid model with DT and RF to enhance the task. The
finding suggests that utilizing the RF technique and a hybrid model,
heart disease detection is effective. DT has a 79% accuracy rate, while
RF has an 81% accuracy rate, whereas the hybrid model has 88%.
Motarwar et al. [38] propose a ML system that uses several methods
to predict the chances of developing a cardiac disease. Five algorithms
are used to run the framework: NB, RF, Logistic Model Tree, DT, and
SVM. The algorithm is trained and tested by running the Cleveland
dataset. The dataset is collected and processed; then, the most signifi­
cant features consider for feature selection. For this purpose, 80% of the
data (242 instances) use to train the dataset, and the remaining 20% (61
cases) was used for testing. For finding, RF provides the highest level of
accuracy rate with 95.08%.
Rajdhan et al. [39] conducts a comparative assessment of the per­
formance of various ML classification algorithms such as DT, NB, RF,
and LR. The study’s objective was to determine the best effective ML
system for detecting heart conditions using the UCI Cleveland dataset,
which was made accessible for analysis on the Kaggle website. A
detailed description of the 14 characteristics employed in the proposed
study. The suggested work predicts heart disease by investigating the
four classification algorithms listed above and, based on performance,
effectively predicting whether or not the patient has HD. The doctor
inserts the input values from the person’s medical report. The output
data is converted into a system to determine the likelihood of developing
heart problems. The results show that the RF is the most effective
method for predicting CVD, with an accuracy of 90.16 %.
Mohan et al. [40] proposed an approach of random forest hybrid
with a linear model (HRFLM). It is a hybrid of the random forest and the
linear model. The essential characteristics of both methods integrated
the Hungarian, Cleveland, and Switzerland datasets from the UCI re­
pository. KNN, DT, NB, LR, SVM, ANN, Generalized Linear Model,
Gradient Boosted Trees, and Genetic Algorithm are ML techniques that
classify disease severity. HRFLM, a revolutionary approach, predicted
heart disease quite well. The achieved accuracy of HRFLM was 88.7%.
Annepu and Gowtham [41] suggested a Python-based heart disease
prediction framework based on the RF method used for the ML tech­
niques training and testing using the Cleveland datasets from the UCI
repository of HD. These datasets contain 303 instances and 76 features,
but they used nine after pre-processing and manual attribute selection.
The dataset utilized for algorithm training was 75% and 25% for testing.
The results were visualized in visual studio code, created using a
graphical user interface. For the classification, the RF classifier has used,
and the accuracy obtained was 97.56%.
David and Belcy [42] conducted a comparison study on heart disease
using RF, DT, and NB to create a prediction method to examine and
predict the potential of heart disease. The Statlog dataset from the UCI
repository, which included 270 cases and 13 attributes, was utilized for
the model training and testing. The dataset divides into a training model
with 80% and for testing with 20%. The testing results indicate that the
RF technique outperformed the DT and NB in predicting heart disease.
When compared to other algorithms for HD prediction, the RF method
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Medical Engineering and Physics 105 (2022) 103825
performs best with 81.0% accuracy.
Nandhini et al. [43] developed a model for real-time prediction of
cardiovascular disease. Technology develops that can determine the
presence and absence of heart disease in a user, and it is capable of
prediction and diagnosis. The dataset from the UCI repository of com­
mon Cleveland HD datasets, with 303 cases and 76 features, was used to
train and test the algorithm. The small sample size is split into 50% for
training and 50% for testing data to build the ML techniques NB, SVM,
RF, LR, KNN, and DT, which were the machine learning methods
employed. Researchers reveal the RF classifier with an accuracy rate of
89.0% for the prediction of CVD. Their concept was constructed on the
idea that mobile phones would always be linked to the internet, which
isn’t always the case.
4.2. Support vector machine
Chowdhury et al. [44] proposed methodology for heart disease
predictions aims to uncover essential traits using ML algorithms,
resulting in improved prediction accuracy. Instead of gathering data
from an internet repository, researchers collected information from
hospitals and healthcare enterprises in the Sylhet district of Bangladesh
to create a good questionnaire and the most valuable dataset linked to
heart disease prediction. The dataset included 564 occurrences and 18
attributes, and the model employed machine learning algorithms such as
LR, DT, KNN, SVM, and NB, among others. The accuracy of various
methods depends on the instances in the dataset may vary. SVM pro­
duced the best results in the proposed model, with an accuracy of 91.0%
for the threshold instances of the dataset.
Sangya Ware [45] studies intend to examine heart disease diagnosis
using the UCI ML repository of Cleveland datasets, containing 303 cases
and 14 attributes used for this research and evaluation. The datasets
before used for analyses it is pre-processed to remove all of the missing
and noisy data. The study compared six distinct ML approaches based on
several performance metrics: LR, NB, KNN, SVM, RF, and DT. The
analysis reveals that SVM provides the most excellent results, 89.34%.
Li et al. [46] develop a model for a cardiac disease prediction that is
both efficient and accurate and based on ML algorithms. The system
builds on classification techniques such as KNN, DT, ANN, NB, LR, SVM,
and conventional feature selection strategies such as maximum rele­
vance, minimal redundancy, and relief. The feature selection is a unique
rapid conditional information mutual approach used to overcome the
feature selection problem. These feature selection techniques have been
used to boost classification accuracy and lower the execution time.
When compared to other algorithms, the accuracy of SVM is 92.37%.
The proposed technique is simple to adopt in healthcare for detecting
heart problems.
Rishabh Magar [47] proposed a machine learning-based web appli­
cation to predict cardiac disease. It will display the algorithm calculating
the probability of heart disease existence and their outcome on the
webpage. Moreover, reducing the time and cost in predicting the dis­
ease. There are several ML techniques; the algorithms train using the
Cleveland dataset of conditions from the UCI repository. For training,
75% of the entries in the data set were utilized, with the remaining 25%
used to test the algorithm’s accuracy. The four ML algorithms used were
DT, LR, NB, and SVM. Individual datasets were trained and tested for
each of the four algorithms. Different aspects were to be used to identify
the most effective algorithm. With an accuracy of 82.89%, the LR
technique is the most efficient of the four. SVM was 81.57% accurate,
while DT and NB were 80.43% and 80.43% accurate, respectively.
Khan et al. [48] compared some widely used ML techniques for
predict CVD. The ML techniques ANN, SVM, DT, and RIPPER classifiers
use WEKA 3.6 and the model train and tested using the Cleveland
datasets from the UCI repository, containing 303 cases and 14 features.
In the data pre-processing, the classifier sample size with 296 occur­
rences. The selected algorithm’s performance compares to other classi­
fiers such as ANN, NB, and KNN. The model result revealed that the
J. Azmi et al.
selected techniques worked better, with SVM achieving a 90.0% accu­
racy rate.
Lakshmanarao et al. [49] proposed a model for CVD prediction using
machine learning techniques. Various neural systems and data mining
are used to determine the HD severity in patients. Failure to identify the
problem early otherwise impact the heart or result in sudden death. The
data comes from the Kagglerepository’s Framingham database, and the
ML algorithms utilized are LR, RF, SVM, DT, J48, KNN, NB, and Ada­
Boost. The SVM shows to be the best, with an accuracy of 90.3%.
Hariharan et al. [50] conducted a comparisons work on the HD
prediction using ML techniques such as KNN, DT, and SVM classifica­
tion. They used the VA Long Beach dataset from the UCI repository of
heart disease for algorithm training and testing, containing 270 in­
stances and 12 features. A confusion matrix based on the evaluation
conducted for accuracy, specificity, and sensitivity. Their testing results
showed that SVM exceeded DT and KNN in predicting CVD, with a
specificity of 83%, a sensitivity of 100%, and an accuracy of 92.0%.
Nashif et al. [51] offered a preliminary design for a cloud-based
cardiac disease prediction system that would employ ML algorithms.
Two datasets from the UCI repository of HD, the Cleveland dataset (303
instances with 14 attributes) and the VA Long Beach dataset (270 cases
with 14 characteristics), were combined to form extensive data. In ML
techniques, five classification and prediction operations use in the
WEKA, including SVM, RF, NB, Multi-Layer Perception, and LR. SVM
was the best classifier among the other methods, with 97.53% of the
classification accuracy.
4.3. Artificial neural network
Ayatollahi et al. [52] compares SVM and ANN classification for
Positive Predictive Value based CVD prediction. Their sample data came
from three hospitals associated with the Medical Science University,
Iran, containing 1324 cases and 25 attributes. The samples were taken
from admitted patients hospitalized during 2016 - 2017 suffering from
CVD. The data collected from the UCI repository has based on the var­
iables mentioned in the Cleveland data policy guideline. Data
pre-processing, merging, filtering, normalization, and compression were
all used to govern the obtained data and uploaded into Microsoft Excel
2013 and SPSS (v23.0), and statistical computing was performed using R
3.3.2. In the algorithm, the dataset has divided into 70% for training and
30% for testing. Their studies revealed that the ANN algorithm out­
performed in performance sensitivity, power, and accuracy rate 91.75%.
Subhadra and Vikas [53] developed an MLP-based diagnostic system
with backpropagation as the training technique. The proposed system’s
performance examines using precision, accuracy, specificity, and
sensitivity and uses the HD Cleveland dataset from the UCI repository,
with 76 features and 303 cases. These features for dataset pre-processing
excluded six instances with missing values and chose only 14 of the 76
traits as the most critical HD. The experimental result revealed that the
MLP-NN model had a high accuracy of 93.39%.
Meshref [54] create many machines learning classifiers and apply
them to create the best prediction model for heart disease. The data set
used in this study comes from the Cleveland dataset of the UCI re­
pository \, which initially consisted of 303 occurrences and 76 charac­
teristics. Several well-known machine learning approaches, including
DT, ANN, SVM, and NB, have been researched to develop, comprehend,
and interpret various cardiovascular disease predicting models. When
compared to the other models, the ANN model had the highest accuracy
of 84.25%.
Chaithra and Madhu [55] used comparative analysis based on data
mining techniques to create a CVD prediction model. The data used for
testing came from the Transthoracic Echocardiography database, with
336 cases and 24 features. DT-J48, NN, and NB are three prominent ML
models used to analyze and perform classification operations. Their
testing results revealed that the NN classification performed signifi­
cantly better in CVD prediction, with an accuracy rate of 97.91%.
7
Medical Engineering and Physics 105 (2022) 103825
Sabay et al. [56] proposed a methodology for predicting heart dis­
ease that demonstrates how synthetic data may utilize to meet data
leakage and avoid the restrictions of limited medical research datasets.
The surrogate datasets use synthetic observations to model the system
and compare the outcomes of the DT, RF, and LR prediction accuracy
tests. The dataset contains 303 cases with 76 attributes taken from the of
Cleveland dataset of the UCI library and pre-processed into 279 in­
stances with 14 features. They found that utilizing 10-fold
cross-validation using RF, DT, and LR algorithms with surrogate data
could enhance prediction stability by 81%. They improved the accuracy
of CVD prediction using ANN with surrogate data by approximately 16%
to 96.7%.
4.4. K-Nearest neighbor
Bharti et al. [57] propose deep learning and ML techniques to find
the results and analysis of the UCI repository of the HD dataset are the
Cleveland, Long Beach VA, Switzerland, and Hungary. The dataset
consists of 14 features, and 303 cases are used to analyse the perfor­
mance of algorithms with a confusion matrix. The isolation forest han­
dles datasets with irrelevant characteristics and those datasets which are
relevant features for better outcomes. The machine learning algorithms
consider DT, SVM, LR, the application of the deep learning approach in
the model, an accuracy of 94.2%.
Shah et al. [58] shows many heart disease features and a model based
on ML methods such as the RF, DT, KNN, and NB algorithms. It uses
datasets from the Cleveland of the UCI repository of HD patients and
selected 303 cases with 14 features in the collection to test the accuracy
of various algorithms. The results show that KNN achieves the most
excellent accuracy score of 90.78%. The data pre-processes before being
utilized in the model. The algorithms with the most significant outcomes
in this mode include KNN, NB, and RF.
Arghandabi and Shams [59] focused on assessing the performance of
machine learning algorithms’ models used to predict heart issues.
Several ML algorithms utilize to diagnose heart disease in patients at an
early stage. DT, KNN, GB, SVM, and LR algorithms employ for this task,
and the dataset uses from the UCI repository of heart diseases. The
teaching and testing environments are created in the Python program­
ming language using the Jupyter notebook. The training and testing on
machine learning algorithms revealed that the KNN had a high accuracy
of 85.7%.
Singh and Kumar [60] use the UCI repository dataset to train and
evaluate ML algorithms to predict cardiac illness. These algorithms
include LR, DT, KNN, and SVM. Anaconda (Jupytor) notebook is the
finest tool for implementing Python programming since it has various
types of libraries and header files that make the task more exact. The
accuracy of each algorithm is examined using the confusion matrix and
found that KNN has an accuracy of 87.0%, the best and most efficient
algorithm.
Almustafa [61] compares alternative HD dataset models to predict
cardiac illness instances effectively with limited characteristics. For
1025 patients from Cleveland, Switzerland, Hungarian and Long Beach
V, the dataset covers 14 attributes. On the HD dataset, a feature
extraction method is used to remove missing values. To demonstrate the
performance of the selected classification algorithms to classify best and
or predict heart situations, the methods employed NB, KNN, DT, SVM,
JRip, Adaboost, Stochastic Gradient Decent, and DT-J48. After using
several strategies for classifying the HD dataset, the KNN classifier
achieved a classification accuracy of 99.70%.
Rabbi, Uddin et al. [62] has done extensive research in MATLAB on
supervised learning models such as KNN, SVM, ANN, and multilayered
feed-forward backpropagation. The UCI machine learning repository
Cleveland dataset of heart disease was used, which included 303 in­
stances with 76 attributes. The dataset pre-processes to eliminate the
entries with missing values. The resulting data size was 270 cases with
13 attributes. 50% of the information uses to train the models, while the
J. Azmi et al.
other 50% to test them. According to the experimental results, SVM
outperformed in classification accuracy, with an 85.0% success rate.
4.5. Decision tree
Geetha [63] provide a model using ML neural classification for CVD
infection. The neural system framework recognizes 13 features and
forecasts the presence or absence of cardiac disorder and numerous
execution measures in the patient. The dataset for the model was taken
from the Cleveland datasets of the UCI repository of machine learning
and examined 76 attributes and 303 cases. The algorithm employed NB,
Stochastic Gradient Descent, KNN, DT, SVM, and Adaboost to demon­
strate the selected classification performance to classify best and fore­
cast HD instances. DT obtained 99.70% of accuracy.
Gao et al. [64] proposed system aims to apply ensemble methods to
enhance the accuracy of prediction of HD. ML techniques use to predict
the initial phase of heart disease. The dataset obtains from the Kaggle
repository. Ensemble approaches, i.e., bagging and boosting methods,
use two feature extraction techniques (linear discriminant and principal
component analysis) to identify essential features from the dataset. A
comparison of ensemble methods (bagging and boosting) and five
classifiers such as SVM, KNN, DT, NB, and RF perform on selected fea­
tures. The bagging method using DT and principal component analysis
featureextraction approach achieved the highest accuracy of 98.6%
based on experimental observations.
Agrahara [65] presents comparative results on heart disease pre­
diction and draws analytical inferences. According to the study’s find­
ings, DT, KNN, ANN, NB, RF, and LR algorithm approaches improve the
accuracy of the heart disease prediction system in various scenarios.
Ohio chooses as the location for this Cleveland database. A correlation
matrix uses to analyze the data into a more advanced analysis and
diagnostic for advanced studies. Based on the result, DT is the best
because of its high accuracy of 98.02%, high precision, and low MSE. In
comparison, LR and KNN have lower accuracy of 89.0%, less precision,
and higher MSE.
Alotaibi [66] conducted a comparative analysis applying ML tech­
niques to forecast cardiac disease. The algorithms evaluated included
DT, NB, LR, SVM, and RF. The UCI repository of HD provided 303 cases
and 14 features for the standard Cleveland datasets. The 10-fold
cross-validation technique employs during the learning and develop­
ment of the model. According to the findings of the studies, the DT al­
gorithm had the best accuracy of 93.19% in predicting heart disease,
followed by SVM at 92.30%.
4.6. Naive Bayes
Poorani and Hemalatha [67] proposed a machine learning approach;
it creates prediction models to assess the Cleveland datasets from UCI,
containing 76 features and 303 subjects relevant to heart disease (HD).
SVM, DT, RF, Multilayer Perceptron (MLP), and J48 classifiers accept
data from the data frame for testing and training. The random forest and
naive bayes theorems are 90.33% more accurate than other classifiers.
This proper measurement can support the accuracy of HD. The machine
learning approaches used in this work, based on naive bayes and J48,
can improve the efficacy of possible heart disease health studies.
Tarawneh and Embarak [68] developed a hybrid model for pre­
dicting cardiac disease that merges ML techniques into a single frame­
work. The dataset has been taken from the Cleveland UCI repository of
heart disease, including 303 cases and 14 attributes in the model to train
and test the algorithms. Data pre-processing minimizes the number of
characteristics from 14 to 12. The algorithm includes KNN, NB, RF, GA,
J48, and SVM classification, with their respective accuracies, specific­
ities, and sensitivities in CVD prediction taken into account. The ex­
periments revealed that SVM and NB performed better in predicting HD
with 89.2% similar accuracy.
Dhar et al. [69] used an ML algorithm to create a predictive model
8
Medical Engineering and Physics 105 (2022) 103825
for detecting cardiovascular heart disease based on various heart-related
indicators. Three distinct supervised algorithms, namely RF, NB, and
J48 Classifier utilizing the Weka tool of ML software, were used to
pre-process the dataset. Knowledge Discovery of Database (KDD) is used
to extract the heart illnesses dataset from the ERIC laboratory, which
consisted of 209 test cases. The accuracy, precision, recall, and F-mea­
sure, among other benchmark metrics, were used to assess the algo­
rithm’s performance. With a classification accuracy of 100%, the most
effective model for predicting patients with heart disease was RF
implemented on specified attributes.
4.7. Logistic regression
Prasad et al. [70] created a machine learning technique for CVD
prediction based on logistic regression (LR). They used the SK-Learn
module in Python software to compare the LR approach with other
techniques such as NB, KNN, SVM, DT, and J48. Three hospitals
collaborating with the AJA University of Medical Sciences in Iran pro­
vided data on heart problems. There are 1324 instances and 25 features
in the sample. The experimental findings showed that the LR algorithm
worked better, with an accuracy of 86.89%.
Haq et al. [71] created a hybrid model based on ML architecture for
diagnosing CVD patients using seven prominent classification algo­
rithms in Python. NB, KNN, LR, ANN, DT, SVM, and Multilayer
Perception are among them. The Cleveland dataset (303 instances and
76 attributes) was employed to use a 10-fold cross-validation strategy
for model training and testing. The best heart disease symptom features
were chosen using feature selection techniques to eliminate cases with
missing values. The data was refined and evaluated by all the classifiers
with each feature selection algorithm to find the best-performing model.
The testing findings revealed that LR with 10-fold cross-validation had
the best accuracy of 89.0% when selected by the FS algorithm Relief. It is
a better prediction method in terms of accuracy because of the excellent
performance of LR with Relief.
It illustrates the thoroughly analyzed research studies used to predict
CVD as it is a severe life-threatening disease. The parameters selected for
assessing are as below:
5. Gaps in literature
This section will be a handful in assisting scholars in discovering gaps
in the recent literature. The importance of identifying CVD is critical
since it is a life-threaten condition. Table 1 provides information
regarding the potential of each research paper’s limitations. According
to the literature review, the current machine learning framework for
CVD suffer from one of the following limitations.
• Dataset sample: To achieve high accuracy, many of the systems
recommend small sample sizes. The investigation reveals that ML
algorithms show lower performance with a large sample size. In
contrast, the same classifier shows the best accuracy with exclusive
attributes when used on compact and efficient techniques. The
sample size has a significant impact on the estimated levels of
accuracy.
• Data distribution: There are no standard rules for data usage; the
data splitting is random. The majority of the research studies split the
data into 80%:20% or 70%:30% or even 50%:50% to train and test
the dataset. Furthermore, because the data size for each kind of CVD
is limited, the combined results may be affected.
• Data-clinical correlation: Some findings did not match current
healthcare practice, making interpretation more challenging. Meta-
analysis’ usefulness reflects the fact that it improves the study’s
effectiveness by applying the same techniques. As the clinical data is
often insufficient and inconsistent, the majority of machine learning
approaches fail to address consistent performance. Therefore data
clinical correlation is needed.
 Table 1

J. Azmi et al.
Comparison of machine learning techniques for cardiovascular disease prediction.
S.No Author/Year Proposed Work Dataset Used Comparative Proposed Algorithm Accuracy Limitation/Gaps
Algorithm (in %)
1. Nissa, N. et al. (2021) By analyzing algorithms UCI machine learning repository. SVM, DT, RF RF 99.35 The time complexity is not determined, other ML
comparatively for prediction of heart algorithmsare not trained, and framework also not
disease. specified.
2. Dhankhar, A. and S. To find the best algorithm for heart UCI repository for heart disease. DT, RF, ANN, SVM RF 90.00 Small dataset size used, no feature selection, framework
Jain (2021) attack prediction using ML techniques. is not specified.
3. Geetha. S. et al. Framework for cardiac infection using Cleveland dataset from UCI. KNN, NB, DT, SVM, DT 99.70 Complicated architecture, model doesn’t worked on
(2021) Neural system estimation of ML. AdaBoost, huge data, early detection not possible, manually
collecting data is time taken, and prediction is not
appropriate.
4 Ghosh, P. et al. To predict HD in specific Coronary UCI repository from Satlog, DT, GB, KNN, RF RF 99.05 The dependency on a certain feature selection system.
(2021) Artery Disease. Cleveland, Switzerland, VA Long AdaBoost.
Beach and Hungary.
5 Maini, E. et al. Practical and economic prediction Sagar Hospitals, Jayanagar, KNN, RF, AdaBoost, RF 93.60 1670 data from higher income group, robustness of a
(2021) system for early CVDs diagnosis. Bengaluru. ANN, LR. prediction system.
6 Chowdhury, M. N. R. Predicting heart disease using ML Osmani Medical College, Sylhet DT, LR, KNN, NB, SVM 91.00 Data preprocessing is not specified.
et al. (2021). algorithms. MAG, Bangladesh. SVM.
7 Mishra, S. et al. Prediction of HD accurately using the UCI ML repository dataset. KNN, DT, LR, RF, ANN RF 100.00 Unable to identify the specific heart disease, and small
(2021) pickled model in the Flask framework dataset used.
of machine learning technique.
8 Gao, X.-Y. et al. To increase the accuracy of predicting Kaggle heart disease repository. KNN, NB Boosting, DT DT 98.60 A single and small data has chosen, hybrid model with
(2021) cardiac disease using ensemble XGBoost, LR, ANFSI, other algorithms, time duration is not specified for
approaches. ANN, prediction.
9 Padmaja, B. et al. To predict CVDs using machine UCI repository dataset. LR, RF, DT, SVM, NB, RF 93.44 A single and small dataset is used in all classification,
(2021) learning approaches. KNN, GB techniques is not specified for feature selection, and the
processing time is not mentioned.
10 Poorani, S. and D. Predictive models to analyze the Cleveland dataset from UCI. DT, RF, NB, MLP, SVM NB 90.33 A single dataset is used, no comparisons with other
9

Hemalatha (2021) datasets relevant to heart disease datasets, no optimization for classifier performance, and
based on ML techniques. feature selection are also not specified.
11 Bharti, R. et al. Prediction of CVD using ML and DL UCI repository-Cleveland, Long SVM, LR, RF, DT, KNN KNN 84.00 Data used without preprocessing, optimization
(2021) Beach V, Switzerland, and techniques is absent.
Hungary.
12 Kavitha, M. et al. Hybrid model for prediction of CVD. UCI repository. DT, RF RF 88.00 Hybrid model other ML algorithm not used, small size
(2021) dataset is used, no technique applies for increasing the
performance of a classifier, and average accuracy is
obtained.
13 Rajdhan, A. et al. Predicts the probability of CVD and UCI Cleveland dataset available in DT, RF, LR, NB RF 90.16 The small size of data set, feature extraction is not
(2020) classifies a patient’s risk level by the Kaggle. included, the time required for processing is not
applying various ML techniques. mentioned.
14 Shah, D. et al. (2020) HD prediction model based on Cleveland database of UCI DT, NB, RF, KNN, SVM KNN 90.78 For early prediction of heart disease require more
supervised learning algorithms. repository. implementation of the algorithm, a small size dataset is

Medical Engineering and Physics 105 (2022) 103825

used.
15 Agrahara, A. (2020) A study of HD prediction Using ML
algorithms.
Data from the NB, DT, LR, SVM, KNN, RF DT 98.02 Datasets is not specific, Real
Cleveland, Ohio area. experiment unavailable, and
improper feature selection.
16 Sangya Ware et al. To perform a comparative analysis. Cleveland database of UCI SVM, DT, RF, NB, KNN SVM 89.34 Marginal success is achieved, feature selection is
(2020) repository. notconsider for removing missing and noisy data.
17 Li, J. P. et al. (2020) ML approach for the feature selection UCI repository. LR, DT, ANN, KNN, SVM 92.37 A dataset with small sample size,the processing time is
and identification of CVD NB, SVM not mentioned.
18 Arghandabi, H. and A study of ML techniques for the HD UCI HD dataset. DT, KNN, LR, GB, SVM KNN 85.70 Not suitable for early detection of heart problem,
P. Shams (2020) prediction. dataset size is small.
19 Magar, R. et al. Cloud-based ML algorithms to get the Cleveland database of UCI SVM, DT, NB, LR SVM 81.57 A small sample size is used for the model, and the system
(2020) prediction of HD repository. is not guaranteed as no performance metrics are
evaluated.
(continued on next page)
 J. Azmi et al.
Table 1 (continued )
20 Motarwar, P. et al. A ML system to predict the chances of UCI dataset of the Cleveland. NB, DT, RF, SVM and RF 95.08 The time required for the prediction is not considered,
(2020) developing a cardiac disease. Logistic Model Tree and the Data size is small.
(LMT)
21 Almustafa, K. M. To compare alternative HD dataset UCI repository-Cleveland, Long NB, KNN, SVM, JRip, KNN 99.70 It’s required to run the model on different classifiers for
(2020) models to predict HD instances. Beach V, Switzerland, and SGD, DT J48, analysis.
Hungary. Adaboost
22 Singh, A. and R. Compute the accuracy of ML UCI machine learning repository. DT, LR, KNN, SVM. KNN 87.0 A single dataset is used, feature extraction not included,
Kumar (2020) algorithms for heart disease prediction not predicting the specific heart problem.
23 Tarawneh, M. and O. Hybridization model used for UCI dataset of the Cleveland. KNN, NB, SVM, ANN, NB 89.2 Small datasets are considered inefficient in predicting
Embarak (2019) predicting HD RF, GA, J48 remote heart disease patients due to limited hospital use
and being unsuitable for open source.
24 Prasad, R. et al. LR based approach for HD prediction. UCI repository. LR, NB, SVM, DT J48, LR 86.89 Datasets used is not specified.
(2019) KNN
25 Ayatollahi, H. et al. SVM and ANN-based model to predict AJA University of Medical SVM, ANN ANN 91.75 Lack of performance comparison with other machine
(2019) a value for CDVs. Sciences, Iran. learning algorithm.
26 Subhadra, K. and B. An intelligent automated system Cleveland data of the UCI NB, DT, KNN, SVM, ANN 93.39 A single dataset issued to the proposed model, no
Vikas (2019) incorporating with ML the techniques repository. MNL-NN optimization of classifiers, checking the performance of
for predicting CVD. given classifiers, no feature selection of missing data,
noisy data.
27 Mohan, S. et al. Effective HD prediction using a hybrid Cleveland data of the UCI DT, RF, GLM, LR, RF 88.70 Absence of other ML classification combination to form
(2019) model repository. SVM, DL, NB, GBT. the hybrid model.
28 Annepu, D. and G. A framework on RF algorithm to Cleveland datasetsfrom UCI RF, DT RF 97.56 Early detection of CVD is not possible, it predict the
Gowtham (2019) predict HD. repository. patient with 50% blockage as normal or absence of heart
problem.
29 Meshref, H. (2019) CVD diagnosis using ML interpretation Cleveland HD datasets from UCI ANN, SVM, DT, NB, RF ANN 84.25 43 instances with extreme data making redundancy, no
approach repository. interpretation of post –hoc model.
10

30 Alotaibi, F. S. (2019) To improve the Heart Failure Cleveland datasets of UCI NB, DT, RF, SVM, LR DT 93.10 The dataset is moderate in size, and there are only a few
prediction accuracy repository. patient records in the collection.
31 Khan, S. N. et al. ML techniques have been used for HD Cleveland datasets ofUCI DT, ANN, SVM, SVM 90.00 Comparison of the algorithms are not appropriate.
(2019) prediction through WEKA. repository. RIPPER
32 Lakshmanarao, A. ML methods for detection of heart Framingham datasetsfrom the SVM, LR, KNN, SVM 90.30 The model is not based on a heuristic technique. Data is
et al. (2019) disease. Kaggle Website. AdaBoost, DT-J48, NB, also redundant.
RF
33 Rabbi, M. F. et al. Prediction heart disease using Cleveland datasets from UCI KNN, SVM, RF, NB, KNN 99.70 For the entire process, one dataset was used, and no
(2018) different classification algorithms. repository. MLP contrasts with other datasets were undertaken.
34 Hariharan, K., et al. Heart Disease Prediction using ML Cleveland datasets from the UCI SVM, DT, BT, ANN, SVM 92.00 The technique uses a single and small dataset and does
(2018). Techniques repository. RF, KNN, LR not use a feature selection process.
35 Chaithra, N. and B. To design a CVD prediction model. Transthoracic Echocardiography DT-J48, ANN, NB ANN 97.19 The frequency of incorrect prediction of the
Madhu (2018) database. cardiovascular disease displayed on the classification
matrix.

Medical Engineering and Physics 105 (2022) 103825

36 Nashif, S. et al. An intelligent and user-friendly HD Cleveland HD datasets from UCI MLP, LR, NB, RF, SVM SVM 97.53 The small dataset is used, Data present in the cloud is
(2018). prediction system repository. not secured.
37 David, H. and S. A. A comparative study and analysis Statlog dataset in UCI repository. NB, DT, RF RF 81.00 The average accuracy was calculated using different
Belcy (2018) using classification algorithms datasets.
38 Haq, A. U. et al. A hybrid smartML based predictive Cleveland HD datasets from the NB, DT, KNN, SVM, LR 89.00 Using feature selection methods and optimization
(2018) system. California Irvine repository. ANN, LR, MLP approaches with a limited number of features.
39 Dhar, S. et al. (2018) A hybrid technique for HD prediction The ERIC laboratory. J48, NB, RF NB 81.00 Data inconsistencies, missing values, noisy data, and
outliers are all examples of data errors.
40 Sabay, A. et al. The framework uses synthetic data for UCI dataset of the Cleveland. LR, DT, RF, ANN ANN 96.70 Using of surrogate sets of synthetic data.
(2018) HD prediction.
41 Nandhini, S. et al. Real-time heart diseases prediction. UCI repository-Cleveland. KNN, NB, RF, LR, DT, RF 89.00 Mobile phones always linked to the internet.
(2018) SVM
J. Azmi et al.
• Feature selection: Most studies have ignored the impact of feature
selection approaches on the spilt of data into testing and training.
The literature shows that a good feature selection approach can help
machine learning models perform better. It also reduces issues such
as higher processing costs caused by inappropriate input data in the
learning process.
• Hyper-parameters optimization: Another vital gap in the existing
research is parameter tuning. The performance of a system can
improve more by fine-tuning its parameters. Algorithm hyper-
parameter customization is typically kept anonymous, leading to
significant statistical heterogeneity.
• Meta-heuristic technique: Meta-heuristics comprises of intelligent
techniques for improving the accuracy of heuristic operations. In our
study we have shown that majority of the researchers have presented
a heuristic machine learning framework for predicting cardiovas­
cular disease. The main applications of Heuristics techniques is for
locating appropriate or near optimum solutions at a low computa­
tional cost without ensuring accessibility.
• Ensemble technique: Current studies ignore the optimistic
ensemble techniques in improving the efficiency of existing ML
models for predicting cardiovascular diseases. Ensemble modelling
combines the findings of two or more related but distinct analytical
models into a single score.
• Clinical Aspect: Some research reported the technical components
without the clinical features due to a lack of clinical monitoring.
Clinical models are used to provide patient data to assist physicians
in making better decisions for their treatment.
6. An overview of CVD classification techniques
Fig. 10 depicts the general framework used for the classification of
cardiovascular diseases. The dataset for CVD is made up of patient data
and is available on the internet. Researchers have used a variety of
dataset sources, including the UCI machine learning repository, Statlog,
Cleveland, Long Beach dataset, and others [72].
The dataset consists of different attributes about the patients’ age,
gender, blood pressure, smoking habit, diabetes, hypertension, chest
discomfort type, family history, etc [3]. The dataset is initially
pre-processed and cleaned to eliminate any missing values and
normalize the attributes indicated in the Fig. 10. All of the individuals’
characteristics extract at the feature extraction stage. The test dataset
has obtained from other sources utilized to classify the various features
using different machine learning classifications such as DT, NB, RF,
KNN, ANN, LR, and SVM to create the model. The predictive model will
categorize the dataset as an affected or healthy person depending on the
attributes.
Fig. 10. General framework for cardiovascular diseases classification.
11
Medical Engineering and Physics 105 (2022) 103825
7. Discussion
All selected papers are assessed thoroughly against some defined
parameters such as the research problem, proposed approach, machine
learning classification used, and accuracy that gives the highest scores in
their respective models used to evaluate and analyze the research
studies. The selected articles apply their technique to the heart disease
dataset, but their sources are unrestricted. The dataset obtains from UCI,
a hospital, or any other repository of machine learning datasets with
cardiac conditions. Researchers that develop machine learning algo­
rithms include utilizing reduction strategies or feature selection while
providing the data to the ML classifier. The most critical characteristics
in the earlier type are chest discomfort, blood pressure, fasting blood
glucose level, cholesterol, ECG readings, maximal pulse rate, exercise,
age, gender, etc. Because the aim of the study focuses on saving lives, the
accuracy of the classifier is one of the most critical aspects of the anal­
ysis. According to several studies, machine learning researchers did not
pay much attention to using other CVD datasets to construct clinical
decision support systems. According to the 41 research that looked at 12
different datasets, more than 75% of such systems employ UCI heart
disease data. In this example, the best approach was described as having
a higher frequency of use, and our survey found that three of these
methods were the most often employed for CVD prediction using the
dataset. Fig. 11: illustrates the different ML models use in the current
researches.
Fig. 11, it was not able to generalize the performance of a single
algorithm as the best because RF appeared with the highest frequency of
accuracy (13 occurrences out of 41). In contrast, the SVM technique
seemed to be second inaccuracy (8 instances out of 41) because each
algorithm is distinct. For example, RF frequently outperforms other
methods on a dataset with a large dimensionality, while others under­
perform on the same data. Though the UCI data uses in most clinical
decision support systems for CVD prediction, other researchers have
Fig. 11. Techniques used in current researches.
J. Azmi et al.
used alternate datasets and machine learning techniques to achieve
similar results. The seven classifiers addressed the CVD prediction
method. There are various forms of machine learning algorithms that
have previously been the subject of several studies. DT, RF, NB, LR,
ANN, KNN, and SVM are some of the techniques we have used in our
study. The accuracy of the RF, SVM, and KNN algorithms is reasonably
high when compared to other techniques, according to the results of this
study.
8. Conclusion
Due to the expansion of knowledge, machine learning is becoming
more popular. It enables the extraction of knowledge from massive
amounts of data that are both time-consuming and, in some situations,
unreachable to humans. In the healthcare industry, machine learning-
based solutions are routinely used to evaluate patient data, diagnose
sickness, and suggest treatment alternatives. An analysis of existing
approaches was conducted and compared in order to determine the best
accurate and efficient strategies for predicting cardiovascular disease in
this study. Today, there are a plethora of machine learning techniques to
choose from. In this work, however, seven machine learning algorithms
are given and compared in order to determine the best classifier for heart
disease prediction. The techniques used are KNN, LR, ANN, NB, DT,
SVM, and RF. Based on the recognized research and studies, displays a
performance analysis of many machine learning algorithms and their
accuracies used for Table 1 cardiovascular disease prediction. Random
forest produces the most significant outcomes in terms of accuracy,
according to many research studies on predicting cardiovascular dis­
ease. The findings show that machine learning-based technologies have
the potential to transform the healthcare industry by improving the
entire process of disease prediction and therapy recommendation in the
vast majority of cases.
There is a lot of work to be done in CVD to improve the prediction
model’s efficiency, reliability, and accuracy. In today’s society, the vast
volume of information is automated, dispersed, and neglected. The pa­
per’s future scope is to anticipate cardiac illnesses utilising new ap­
proaches and algorithms in a time-efficient manner. The model is loaded
with more medical information to get a better result, which helps the
cardiologist in concluding a patient’s likelihood of having a heart attack.
Declaration of Competing Interest
None.
Ethical approval
Not required.
Funding
None.
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