Research Paper: Evaluation of a Cardiac Diagnostic Program in a Typical Clinical Setting

CONTEXT The Heart Disease Program (HDP) is a novel computerized diagnosis program incorporating a computer model of cardiovascular physiology. Physicians can enter standard clinical data and receive a differential diagnosis with explanations. OBJECTIVE To evaluate the diagnostic performance of the HDP and its usability by physicians in a typical clinical setting. DESIGN A prospective observational study of the HDP in use by physicians in departments of medicine and cardiology of a teaching hospital. Data came from 114 patients with a broad range of cardiac disorders, entered by six physicians. MEASUREMENTS Sensitivity, specificity, and positive predictive value (PPV). Comprehensiveness: the proportion of final diagnoses suggested by the HDP or physicians for each case. RELEVANCE the proportion of HDP or physicians' diagnoses that are correct. Area under the receiver operating characteristic (ROC) curve (AUC) for the HDP and the physicians. Performance was compared with a final diagnosis based on follow-up and further investigations. RESULTS Compared with the final diagnoses, the HDP had a higher sensitivity (53.0% vs. 34.8%) and significantly higher comprehensiveness (57.2% vs. 39.5%, p < 0.0001) than the physicians. Physicians' PPV and relevance (56.2%, 56.0%) were higher than the HDP (25.4%, 28.1%). Combining the diagnoses of the physicians and the HDPs, sensitivity was 61.3% and comprehensiveness was 65.7%. These findings were significant in the two collection cohorts and for subanalysis of the most serious diagnoses. The AUCs were similar for the HDP and the physicians. CONCLUSIONS The heart disease program has the potential to improve the differential diagnoses of physicians in a typical clinical setting.