Artificial intelligence predictive analytics in heart failure: results of the pilot phase of a pragmatic randomized clinical trial.

Feb 12, 2024

Contributors: Konstantinos Sideris, Charlene R Weir, Carsten Schmalfuss, Heather Hanson, Matt Pipke, Po-He Tseng, Neil Lewis, Karim Sallam, Biykem Bozkurt, Thomas Hanff, Richard Schofield, Karen Larimer, Christos P Kyriakopoulos, Iosif Taleb, Lina Brinker, Tempa Curry, Cheri Knecht, Jorie M Butler, Josef Stehlik

We conducted an implementation planning process during the pilot phase of a pragmatic trial, which tests an intervention guided by artificial intelligence (AI) analytics sourced from noninvasive monitoring data in heart failure patients (LINK-HF2).
A mixed-method analysis was conducted at 2 pilot sites. Interviews were conducted with 12 of 27 enrolled patients and with 13 participating clinicians. iPARIHS constructs were used for interview construction to identify workflow, communication patterns, and clinician’s beliefs. Interviews were transcribed and analyzed using inductive coding protocols to identify key themes. Behavioral response data from the AI-generated notifications were collected.
Clinicians responded to notifications within 24 hours in 95% of instances, with 26.7% resulting in clinical action. Four implementation themes emerged: (1) High anticipatory expectations for reliable patient communications, reduced patient burden, and less proactive provider monitoring. (2) The AI notifications required a differential and tailored balance of trust and action advice related to role. (3) Clinic experience with other home-based programs influenced utilization. (4) Responding to notifications involved significant effort, including electronic health record (EHR) review, patient contact, and consultation with other clinicians.
Clinician’s use of AI data is a function of beliefs regarding the trustworthiness and usefulness of the data, the degree of autonomy in professional roles, and the cognitive effort involved.
The implementation planning analysis guided development of strategies that addressed communication technology, patient education, and EHR integration to reduce clinician and patient burden in the subsequent main randomized phase of the trial. Our results provide important insights into the unique implications of implementing AI analytics into clinical workflow.

Published by Oxford University Press on behalf of the American Medical Informatics Association 2024.

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ABOUT THE CONTRIBUTORS

Konstantinos Sideris, Charlene R Weir, Carsten Schmalfuss, Heather Hanson, Matt Pipke, Po-He Tseng, Neil Lewis, Karim Sallam, Biykem Bozkurt, Thomas Hanff, Richard Schofield, Karen Larimer, Christos P Kyriakopoulos, Iosif Taleb, Lina Brinker, Tempa Curry, Cheri Knecht, Jorie M Butler, Josef Stehlik
Konstantinos Sideris

Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States.

Charlene R Weir

Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States.

Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States.

Carsten Schmalfuss

Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States.

Heather Hanson

Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States.

Matt Pipke

PhysIQ, Inc., Chicago, IL 60563, United States.

Po-He Tseng

PhysIQ, Inc., Chicago, IL 60563, United States.

Neil Lewis

Cardiology Section, Medical Service, Hunter Holmes McGuire Veterans Medical Center, Richmond, VA 23249, United States.

Department of Internal Medicine, Division of Cardiovascular Disease, Virginia Commonwealth University, Richmond, VA 23249, United States.

Karim Sallam

Cardiology Section, Medical Service, VA Palo Alto Health Care System, Palo Alto, CA 94304, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States.

Biykem Bozkurt

Cardiology Section, Medical Service, Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States.

Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States.

Thomas Hanff

Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States.

Richard Schofield

Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States.

Karen Larimer

PhysIQ, Inc., Chicago, IL 60563, United States.

Christos P Kyriakopoulos

Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States.

Iosif Taleb

Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States.

Lina Brinker

Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States.

Tempa Curry

Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States.

Cheri Knecht

Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States.

Jorie M Butler

Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States.

Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States.

Josef Stehlik

Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States.