2020 9th M EDITERRANEAN C ONFERENCE ON E MBEDDED C OMPUTING
Review of Artificial Intelligence Application in
Cardiology
Almina Šećkanović, Marijana Šehovac
Faculty of Pharmacy
University of Sarajevo
Sarajevo, Bosnia and Herzegovina
Mirsad Kacila
Clinical Center of University of Sarajevo
Sarajevo, Bosnia and Herzegovina
Abstract - Increasing incidence of cardiovascular disease and
their mortality rate render them as second leading cause of
death worldwide. Artificial Intelligence (AI) is used in many
fields of science and industry, but also has found its use in
medicine for diagnosis, treatment and prediction of diseases.
This paper presents the review of AI application in
cardiology. The review is based on research papers published
in Medline database. Findings of the review indicate that,
according to accuracy parameter, the overall performance of
AI based models for cardiovascular application is above
83%. Based on the results, AI algorithms and deep learning
can be rendered as accurate, hence showing possibility to be
used as a diagnostic tool now and in the future. New era of
modern diagnosing is coming and Artificial Intelligence has
the potential to change the way in which medicine is
practiced.
Keywords - artificial intelligence, cardiovascular diseases,
machine learning
I. INTRODUCTION
Cardiovascular Diseases (CVDs), are the leading cause of
death worldwide accounting for 30% of deaths in 2014 in
United States [1] and 45% of deaths in Europe. They
present a financial burden to healthcare with estimated cost
of 210 billion euros per year just for the European Union
[2]. Current protocols in diagnosis of CVDs are based on
static and dynamic assessment of patients - medical
history, biomarkers, physical examination, specific test.
[3-4] The medical specialist interprets the results of these
examinations based on their professional clinical
knowledge and experience to determine diagnosis and
treatment for the patients. This kind of procedure is
increasingly proven error-prone and inefficient due to both
inconsistency between medical professionals and human
error rates [6].
Recently, various tools based on advanced technology
have been introduced in healthcare to reduce risk of faulty
diagnosis and treatments of the patients. [7-9] Primarily,
those are tools based on artificial intelligence (AI) [10] and
are able to stimulate processes similar to human
intelligence. Nowadays, AI tools are used in healthcare for
variety of tasks, from medical
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(MECO), 8-11 J UNE 2020, B UDVA , M ONTENEGRO
Lemana Spahić, Irma Ramić, Nuraiym
Mamatnazarova, Lejla Gurbeta Pokvić, Almir
Badnjević
Faculty of Engineering and Natural Sciences
International Burch University
Sarajevo, Bosnia and Herzegovina
lemana.spahic@stu.ibu.edu.ba
gurbeta.lejla@ibu.edu.ba
to diagnosis and treatment of various diseases such as
diagnosis of urinary tract infection [15], cancer and tumors
[16], obstructive lung disease[17-19], chronic diseases
such as diabetes [20].
According to research done by World Health Organisation,
over 5% of adults experience diagnostic errors. Most
common diagnostic errors were examined by a study
which evaluated 190 of these cases, and came to a
conclusion that congestive heart failure is misdiagnosed in
7% of cases, which is a higher incidence than cancer
misdiagnosis (5%). Delayed diagnosis of cardiovascular
conditions is hazardous because the clinical outcomes and
chances of recovery deteriorate quickly in these situations.
Diagnostic errors may be caused by disregarding subtle
premonitory symptoms, hence not performing laboratory
tests and further medical checkup on important cardiac
parameters such as hypertension or high blood sugar and
cholesterol levels [21].
Benefits of using AI in healthcare are based upon keeping
and manipulating large databases as it doubles every 73
days, improving clinical reliability as it cross-references it
with worldwide data thereby also improving reliability and
clinician to clinician communication, reduces human error
and decreases mortality rates with more readily
identification of the diseases. Another key aspect to
consider in terms of benefits of using AI in healthcare is
cost reduction reported to be as high as 30-40 % in terms
of improving patient outcomes, and 50% in terms of
treatment cost savings [22-23].
AI methodologies most prominently used for machine
learning in medicine are neural networks (both ANN and
Deep and Convolutional Networks), Random Forest (RF),
Naive Bayes (NB), Support Vector Machines (SVM) and
k-Nearest Neighbor (k-NN). All of these algorithms have
a common point in their capacity to interpret vast amounts
of data and infer relationships between them. However,
neural networks differ from other ML algorithms in their
capacity to learn from each subsequent iteration of the
data. RF use different combinations of various decission
trees to evaluate different features and make a final
conclusion [24]. NB classifiers use Bayesian rules to draw
 2020 9th M EDITERRANEAN C ONFERENCE ON E MBEDDED C OMPUTING (MECO), 8-11 J UNE 2020, B UDVA , M ONTENEGRO

inferences based on probability [25]. SVM are linear - The paper is published in the timeframe of 2015
classification models working based on creation of to 2020, with focus on 2019
multiple hyperplanes and using their overlaps for - The paper is indexed in Medline scientific
classification [26]. k-NN is a distance-based classification database
algorithm suitable for smaller datasets [27]. - It is focused on machine learning and artificial
Risk determination and prediction are key aspects of AI, intelligence and its use in cardiology
and they can be extremely important in elimination of - Keywords: machine learning, artificial
diagnostic errors [28]. Since the application of AI is highly intelligence, cardiology
presented in scientific and public consciousness, this paper - Accuracy of the proposed model is above 80%
aims to present applications specifically in the field of - Performance evaluation done in terms of
cardiology. Presenting the data in a comprehensive way, specificity, sensitivity, accuracy and area under the curve
this paper aims to serve as an accelerator for future (AUC)
development of AI applications in cardiology. III. RESULTS
The results of review of AI applications in healthcare for
II. MATERIALS AND METHODS diagnosis and treatment of CVDs are presented in Table I.
For the paper to be included in this review, the following
criteria had to be met:
TABLE I. STUDIES USING DIFFERENT AI METHODOLOGIES FOR CARDIOVASCULAR APPLICATIONS

PAPER DESCRIPTION
REFERENCE
CARDIOLOGICAL
TASK DISORDER/DISEASE
AI METHODOLOGY PERFORMANCE

CONVOLUTIONAL 83.30%
[29] DIAGNOSIS ATRIAL FIBRILLATION
NEURAL NETWORK (CNN) MEDIUM

GRADIENT
OBSTRUCTIVE CORONARY 73.80%
[30] DIAGNOSIS BOOSTING MACHINE
ARTERY DISEASE LOW
(GBM)

MURMUR DETECTION 88%

[31] DIAGNOSIS HEART MURMURS ALGORITHM MEDIUM

SUPPORT VECTOR
MACHINES, NAIVE BAYES, 94.10%
[32] DIAGNOSIS ARRHYTHMIA K-NEAREST-NEIGHBORS, HIGH
AND RANDOM FOREST

ARTIFICIAL 92.86%
[33] DIAGNOSIS MYOCARDIAL INFARCTION
NEURAL NETWORK (ANN) HIGH

UNSUPERVISED
STATISTICAL METHOD 85%
[34] DIAGNOSIS HEART FAILURE COMBINED WITH A MEDIUM
SUPERVISED CLASSIFIER

CONVOLUTIONAL 89.50%
[35] DIAGNOSIS HEART FAILURE
NEURAL NETWORK MEDIUM

EXPERT SYSTEM
SEVERE AORTIC 100%
[36] DIAGNOSIS (ARTIFICIAL NEURAL
STENOSIS HIGH
NETWORK)

LEFT VENTRICULAR BAYESIAN ADDITIVE 82.90%

[37] DIAGNOSIS
HYPERTROPHY REGRESSION TREES MEDIUM

ARRHYTHMIAS, SINUS DEEP NEURAL 83.70%

[38] CLASSIFICATION RHYTHM AND NOISE NETWORK (DNN) MEDIUM

ASYMPTOMATIC LEFT
AI BASED 85.70%
[39] CLASSIFICATION VENTRICULAR(LV)
DYSFUNCTION
ALGORITHM MEDIUM

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 2020 9th M EDITERRANEAN C ONFERENCE ON E MBEDDED C OMPUTING (MECO), 8-11 J UNE 2020, B UDVA , M ONTENEGRO

CONVOLUTIONAL
AUTO-ENCODER BASED
NON-LINEAR COMPRESSION 99%
[40] CLASSIFICATION ARRHYTHMIA COMBINED WITH LONG- HIGH
SHORT TERM
MEMORY CLASSIFIER

MORTALITY OF
PATIENTS WITH DEEP NEURAL 90.50%
[41] CLASSIFICATION
ACUTE MYOCARDIAL NETWORK HIGH
INFARCTION

DEEP UNIFIED 76.40%

[42] PREDICTION HEART FAILURE
NETWORKS (DUN) LOW

K-NN, RANDOM 65% - 84%

[43] PREDICTION HEART FAILURE FOREST, AND DECISION LOW
TREE

GRADIENT 84%
[44] PREDICTION ISCHEMIA BOOSTING MACHINE MEDIUM
(GBM)

MORTALITY DUE TO
88.40%
[45] PREDICTION ACUTE HEART DEEP NEURAL NETWORK
MEDIUM
FAILURE

82.70%
[46] PREDICTION ATRIAL FIBRILLATION NEURAL NETWORK
MEDIUM

INCIDENT ATRIAL DEEP NEURAL 80%

[47] PREDICTION
FIBRILLATION NETWORK MEDIUM

CARDIOVASCULAR 76.9%
[48] PREDICTION GRADIENT BOOST
DISEASE RISK LOW

As it can be seen from the Table I, the twenty discussed
papers are dealing with a variety of applications of AI in
cardiology from diagnosis through classification to
prediction. Diagnosis of atrial fibrillation and heart failure
are both based on CNN, while myocardial infarction is
based on a simpler ANN. The obtained accuracies for [29]
and [35] are 83.50% and 89.50% respectively, which
suggests that atrial fibrillation has data more convenient
for processing via neural networks when compared to heart
failure. Myocardial infarction diagnosis was predicted
with 92.86% accuracy which was expected as this is a
terminal state with a very characteristic clinical
presentation. Severe aortic stenosis was automatically
diagnosed with 100% accuracy using implemented expert
system consisting of neural networks. The obtained
accuracies suggest that neural networks are concurrent
candidates for diagnosis of cardiac diseases. Other AI
strategies used for diagnosis are SVM, NB, K-NN, RF and
GBM [30,34,32]. These methodologies differ from neural
networks in terms of the amount of data necessary for
prediction, with them needing generally less data than
neural networks but neural networks can interpret
ambiguous data as they learn by each iteration. The
performance of these classifiers in case of diagnosis ranges
from 73.80% to 94.10% which again renders them useful.
The highest accuracy was achieved when diagnosing
arrhythmia using a comprehensive database containing
signals from holter monitoring [32]. However, the overall
accuracy of these methods is satisfactory and their
improved versions could be used for aid in diagnosis of
cardiac conditions. Classification tasks are most often
performed on arrhythmias, as their databases are available
publicly online, and contain a lot of information.
Classification is a more challenging task when compared
to diagnosis, as its goal is finding those sleek differences
between similar clinical states. Most prominently used
methodology for classification is deep learning using
neural networks, interestingly in the field of arrhythmia
classification. Classification of risk associated with illness
is another aspect of classification problem, implemented
also in cardiology in the work of [38-41]. This system
based on deep neural network, managed to accurately
predict risk in 90.5% of cases. Even though this is more
challenging than classification of [39] because of the large
variation scope, studies are aiming towards making
differentiation between different arrhythmias easier and
the study performed by [40] reached a remarkable
accuracy of 99%. Prediction tasks are similar to those of
diagnosis in terms of differentiation between conditions,
however, prediction is more sophisticated in terms of
importance. Prediction of heart failure and atrial
fibrillation was done using neural networks, deep learning
in terms of DUN and machine learning using KNN, GB
and RF [42-48]. The obtained results however, are not in
the accuracy ranges of previously mentioned research.
ANN applications in predicting atrial fibrillation reached
accuracy of 82.70%, DNN for mortality prediction due to
acute heart failure reached 88.40%, DUN reached 76.40%
accuracy while the accuracy of KNN and RF varied
drastically, from 65% to 84%. This indicates the challenge

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 2020 9th M EDITERRANEAN C ONFERENCE ON E MBEDDED C OMPUTING
behind predicting heart failure as it is dependent on so
many factors and co-occurrence of those factors.
IV. CONCLUSION
AI has a broad spectrum of usage in medicine. In this
paper, we presented a review of research related to using
Artificial Intelligence in cardiology. Machine learning,
deep learning, and cognitive computing are promising and
can potentially change the way in which medicine is
practiced, but physicians need to become aware and open
minded about upcoming AI era. It can make everyday
procedures more effective on different levels. However,
usage of AI in medicine is faced with challenges in terms
of ethics, privacy and patient confidentiality and the
confidence of the methodology itself. All of these potential
limitations of using AI in cardiology are being discussed
globally, and by different scientific government
institutions like the FDA and EDA. Still there is no unique
regulation or recommendation. However, scientific
research is the best proof of the benefits that this approach
is giving to medicine. The implementation of deep learning
with unsupervised features for big data analytics holds
significant potential for different diagnosis, like diagnosis
of atrial fibrillation, obstructive coronary artery disease,
heart murmurs etc..
One of the main difficulties arising during this review was
a lack of overlap between machine learning algorithms
used in the field of cardiology, which made comparison of
the papers according to any of the potential parameters
difficult. However, as the goal of using AI in this field is
to avoid delay in CVD diagnosis which leads to increased
mortality, any of the ML algorithms showing high
accuracy can be potential diagnostic contributors. Another
imposed difficulty is lack of information about the quality
of the databases in terms of equipment used to collect the
data and data processing algorithms.
Machine learning, deep learning, and cognitive computing
are promising and can potentially change the way in which
medicine is practiced, but physicians need to be prepared
for the upcoming AI era. The key is to provide a
background for cooperation between healthcare
professionals, engineers, data analysts and IT experts, for
them to reach a common point in discussing and resolving
the problems in using AI in cardiology. This way of
practicing medicine is very promising, and it will
definitely develop even more in the upcoming years.
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