Clinical Implementation of a Novel Decision Support Tool in Patients With Ischemic Heart Disease (PM Heart)

The PM-Heart algorithm (PMHeartIHD) is an in-house developed software that predict the survival prognosis for the individual patient hospitalized with ischemic heart disease (IHD) after a coronary arteriography has been performed. The software is intended to be used as a clinical decision support system i.e. the calculated survival prognosis is expected to enhance the quality of the treating physician's therapeutic considerations concerning (minor) adjustments to the patients treatment and follow-up - all within the framework of the current medical guidelines. Thus, the algorithm does not "show the physician specifically what to do", but rather ensures a better knowledgebase for the overall interpretation and choice of management of the patient.

To investigate the clinical usefulness of the developed clinical decision support system - the PMHeartIHD algorithm - we wish to investigate whether the clinical use of the algorithm will; Improve patient prognosis and, Minimize the risk of re-hospitalization, compared to patients who are treated without the attending/treating physician knowing the algorithm's prognosis?

The one-year mortality prediction, calculated by the PM Heart algorithm, will not be available to the physician.

The one-year mortality prediction, calculated by the PM Heart algorithm, will be available to the physician.

The calculated prediction and the explainability factors will be made available to the physician, which the physician then can decide to take into his/hers evaluation about further treatment.

A composite outcome of a) readmissions within one month, and 2) all-cause mortality within one year - for patients randomized to the study. All the outcomes listed below will be assessed as a comparison between the "intervention group" and the "control group".

A composite outcome of a) readmissions within one month, and 2) all-cause mortality within one year - for patients randomized to the study.

Readmission(s) within 30 days of the randomization. Incl. information on the quantity, duration, cause, outcome etc.

Cardiovascular readmission(s) within 30 days of the randomization. Incl. information on the quantity, duration, cause, outcome etc.

Readmission(s) with acute coronary syndrome. Incl. information on the quantity, duration, cause, outcome etc.

Length (i.e. total number of days) of the primary hospitalization (i.e. when the patient is randomized to the study).

Number and type of performed cardiac investigations; i.e. TTE, KAG, Heart-CT, Holter/R-tests, ECG, blood samples, etc.

Health economic analyses: How does implementing the algorithm alter the overall costs and resource spending, incl. e.g. social benefits, compared with standard-of-care. i.e. does knowing a more precise 1-year mortality prediction reduce/increase the resource consumption. Will be based on economic analyses of the costs related to the abovementioned outcome measurements.

We wish to investigate how the algorithm is introduced and received in the clinic, both by the medical staff but also the patients. Will be investigated using interviews.

The usability of the algorithm i.e. is it easy to use/understand, any praise or criticisms, ideas for new features etc. Will be based on questionaires and feedback from users.

We wish to investigate how, and to what extend, the algorithm is used by the medical staff, e.g. are the medical staff inclined to use the prediction, does it alter their treatment choices etc. Will be based on questionaires, interviews, feedback from users, and assessment of "look-ups".

Inclusion Criteria: Hospitalized patients in one of the involved departments of cardiology (see below) with; Ischemic heart disease; the clinical presentation may be stable, worsening/unstable angina, non-ST-elevation myocardial infarction or ST-elevation myocardial infarction, and with - Significant coronary artery lesions or diffuse coronary artery disease on invasive coronary angiography during the admission Exclusion Criteria: <18 years of age Living outside Denmark