A translational bioethical & implementation framework for the use of artificial intelligence in cardiovascular medicine

Artificial intelligence (AI) in cardiology is rapidly expanding, but enthusiasm for anticipated benefits should be balanced by a more critical inspection of ethical concerns. In this state-of-the-art review, we discuss the four pillars of bioethics and their overlap with AI regulatory requirements to identify the potential gain and challenges, for both cardiologists and cardiac patients alike, in integrating AI-based clinical tools within various aspects and settings of care. By investigating the current gaps in regulatory oversight and illustrating hypothetical case scenarios, we aim to locate points of weakness along the course of implementation, from algorithm design to tool misuse, which endanger autonomy, beneficence, nonmaleficence, and justice if AI production proceeds without further attention into safeguard development. Finally, we propose governance principles and priorities for AI in cardiovascular medicine to highlight areas where a bioethical-regulatory framework needs to be adapted in order to ensure responsible use of AI in patient care.