Lin AI-ECG alert

AI-Enabled Electrocardiography Alert Intervention and All-Cause Mortality: a Pragmatic Randomized Clinical Trial

Patient / Population Intervention / Exposition Vergleich Endpunkt

In 15,965 hospitalised patients under the care of 39 physicians at multiple sites, an AI-ECG alert flagging patients predicted to be at high risk of death reduced all-cause mortality within 90 days compared with usual care without the alert.

15.965

Design

Pragmatic multisite RCT (39 physicians)

Endpunkt

All-cause mortality within 90 days

Relevanz

Ergebnis90-day all-cause mortality 3.6% vs 4.3% (HR 0.83, 95% CI 0.70–0.99); in patients with high-risk ECGs HR 0.69 (95% CI 0.53–0.90) and cardiac death 0.2% vs 2.4% (HR 0.07, 95% CI 0.01–0.56), with more intensive care in the intervention arm.

Lin CS, et al. Nat Med. 2024;30(5):1461-1470. 10.1038/s41591-024-02961-4

Diskussion & Kritik

The first randomised trial in which an AI-ECG alert reduced a hard outcome — mortality — rather than a diagnostic yield, and the strongest outcome evidence for AI-ECG to date. The authors concede the mechanism is not fully elucidated (more intensive care for flagged patients is the likeliest pathway), the upper confidence bound approaches 1, the trial was open-label, and randomisation involved only 39 physicians, which limits generalisability.