Implementation of a national AI technology program on cardiovascular outcomes and the health system
Coronary artery disease (CAD) is a major cause of ill health and death worldwide. Coronary computed tomographic angiography (CCTA) is the first-line investigation to detect CAD in symptomatic patients. This diagnostic approach risks greater second-line heart tests and treatments at a cost to the patient and health system. The National Health Service funded use of an artificial intelligence (AI) diagnostic tool, computed tomography (CT)-derived fractional flow reserve (FFR-CT), in patients with chest pain to improve physician decision-making and reduce downstream tests. This observational cohort study assessed the impact of FFR-CT on cardiovascular outcomes by including all patients investigated with CCTA during the national AI implementation program at 27 hospitals (CCTA n = 90,553 and FFR-CT n = 7,863). FFR-CT was safe, with no difference in all-cause (n = 1,134 (3.2%) versus 1,612 (2.9%), adjusted-hazard ratio (aHR) 1.00 (0.93-1.08), P = 0.97) or cardiovascular mortality (n = 465 (1.3%) versus 617 (1.1%), aHR 0.96 (0.85-1.08), P = 0.48), while reducing invasive coronary angiograms (n = 5,720 (16%) versus 8,183 (14.9%), aHR 0.93 (0.90-0.97), P < 0.001) and noninvasive cardiac tests (189/1,000 patients versus 167/1,000), P < 0.001). Implementation of an AI-diagnostic tool as part of a health intervention program was safe and beneficial to the patient pathway and health system with fewer cardiac tests at 2 years.
Authors
- John Pierre Greenwood (ORCID: https://orcid.org/0000-0002-2861-0914)
- Justin Carter
- Imran Sunderji (ORCID: https://orcid.org/0000-0001-7568-6113)
- Sarah Mullen (ORCID: https://orcid.org/0000-0002-1387-8934)
- Edward Nicol (ORCID: https://orcid.org/0000-0001-6019-9259)
- Sumeet Sharma (ORCID: https://orcid.org/0000-0001-9889-2913)
- Anna Beattie
- Gerry P McCann (ORCID: https://orcid.org/0000-0002-5542-8448)
- Oliver John Watson (ORCID: https://orcid.org/0000-0003-2374-0741)
- Andrew M. Beale (ORCID: https://orcid.org/0000-0002-0923-1433)
- Jennifer Crooks
- Campbell Rogers (ORCID: https://orcid.org/0000-0003-3955-7650)
- Sri Iyenger
- Nicholas G. Bellenger
- Russell Bull (ORCID: https://orcid.org/0000-0001-5173-327X)
- Benjamin Hudson
- Jonathan Richard Weir-McCall (ORCID: https://orcid.org/0000-0001-5842-842X)
- Hatef Mansoubi
- Peter Haworth (ORCID: https://orcid.org/0009-0004-2762-0127)
- Peter O’Kane (ORCID: https://orcid.org/0000-0001-5245-4547)
- Matthias Schmitt (ORCID: https://orcid.org/0000-0001-8514-0261)
- Victoria Parish (ORCID: https://orcid.org/0000-0001-9895-1178)
- Vinod Venugopal (ORCID: https://orcid.org/0009-0000-9683-834X)
- Manish Motwani (ORCID: https://orcid.org/0000-0003-4483-5168)
- Matthew Shaw (ORCID: https://orcid.org/0000-0001-9184-5591)
- Liam Mullen (ORCID: https://orcid.org/0000-0002-4569-3264)
- Jonathan Rodrigues (ORCID: https://orcid.org/0000-0003-2744-3509)
- Laurence P. Tidbury (ORCID: https://orcid.org/0000-0002-7748-8791)
- Aparna Deshpande (ORCID: https://orcid.org/0000-0001-8958-242X)
- Sawan Waidyanatha (ORCID: https://orcid.org/0000-0002-7337-0403)
- Girvan Burnside (ORCID: https://orcid.org/0000-0001-7398-1346)
- Chee Gee Liew
- Timothy A. Fairbairn (ORCID: https://orcid.org/0000-0003-1491-6231)
- Anoop Chauhan
- Simon Duckett (ORCID: https://orcid.org/0000-0001-6044-1201)
- Gregory Y. H. Lip
- Joban Sehmi
- Anna Reid
- Ian Kemp
Institutions
- North Tees and Hartlepool NHS Foundation Trust (GB)
- University of Liverpool (GB)
- University of Leicester (GB)
- King's College - North Carolina (US)
- King's College London (GB)
- University of Hull (GB)
- Leeds Teaching Hospitals NHS Trust (GB)
- University Hospitals of North Midlands NHS Trust (GB)
- West Hertfordshire Hospitals NHS Trust (GB)
- Royal Devon and Exeter Hospital (GB)
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- Dudley Group NHS Foundation Trust (GB)
- University Hospitals of Leicester NHS Trust (GB)
- Harefield Hospital (GB)
- Frimley Health NHS Foundation Trust (GB)
- United Lincolnshire Hospitals NHS Trust (GB)
- Liverpool Heart and Chest Hospital (GB)
- Portsmouth Hospitals NHS Trust (GB)
- Manchester University NHS Foundation Trust (GB)
- Sheffield Teaching Hospitals NHS Foundation Trust (GB)
- Papworth Hospital NHS Foundation Trust (GB)
- Blackpool Teaching Hospitals NHS Foundation Trust (GB)
- HeartFlow (United States) (US)
- Great Western Hospitals NHS Foundation Trust (GB)
- Ashford and St Peter's Hospitals NHS Foundation Trust (GB)
- University Hospitals Sussex NHS Foundation Trust (GB)
- nView Medical (United States) (US)
- Royal United Hospital Bath NHS Trust (GB)
- Bournemouth University (GB)
Publication Details
- Journal
- Nature Medicine
- Published
- 2025-04-04
- DOI
- https://doi.org/10.1038/s41591-025-03620-y
- Citations
- 25
- Primary Topic
- Cardiac Imaging and Diagnostics
- Type
- article
- Field-Weighted Citation Impact
- 34.00
Funders
- Medical Research Council