5 ms·
For non-invasive heart disease risk prediction nothing beat ECG, period. Somehow American Heart Association and its European counterpart are in denial, and sti
by teleforce 2mo ago
For non-invasive heart disease risk prediction nothing beat ECG, period.
Somehow American Heart Association and its European counterpart are in denial, and still pushing dinasour screening mechanism with very low accuracy for heart disease risk prediction.
The standard risk model for CVD based on PREVENT (US) and SCORE-2 (Europe) like parameters are very poor as reported in the recently published paper on the their accuracy performance by the Swedish team [1]. As all CVD risk stratification with cardiologist review (expert-in-the-loop), the most important accuracy metric is sensivity/recall (avoiding false negative that will escape review) of PREVENT and SCORE-2, 26% and 48%, respectively.
The paper alternative proposal increased the sensitivity to 58% by performing clustering instead of conventional regression models as practiced in the PREVENT and SCORE-2.
These type of models including the latest proposal performed very poorly as indicated by their otherwise excellent and intuitive display of graphical abstract results [1].
[1] Risk stratification for cardiovascular disease: a comparative analysis of cluster analysis and traditional prediction models:
https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwaf013/7954595 https://academic.oup.com/eurjpc/advance-article/doi/10.1093/...
- sscaryterry 2mo agoHow many ECGs can you sell vs how many other snake-oil products? :) (Edit: This is intended to be sarcastic. I agree 100% with the comment) (Edit 2: Added the smiley face)
- justsomehnguy 2mo agoPoe's law in a full swing.
- sscaryterry 2mo agoI didn't know... Thank you
- Aerroon 2mo ago>How many ECGs can you sell vs how many other snake-oil products? A lot, probably. You could sell people on the idea that it should be a part of your yearly health screening. "And if you really care about your health you should do them every 3 months to catch problems early!" or some such.
- sscaryterry 2mo agoThis will work short-term sure, but after about lets say, 3 years of no adverse findings, the average person will not take it seriously anymore.
- alooPotato 2mo agoHuh? I get a blood panel every year and 90% of the things it looks for are normal year after year. But there is always 1 or 2 things flagged that I need to pay attention to. An ECG if it was just part of the normal yearly panel of things that get looked at I don't think ppl will stop doing it just because it doesn't find something right away
- sscaryterry 2mo ago> the average person I do not consider the average HN commenter to be average.
- alooPotato 2mo agoWhat does that have to do anything. The recommendation is to do a blood panel every year I don’t see anything worse about adding ecg to that
- sscaryterry 2mo agoNobody said anything is worse. Half this thread is satire. But on a serious note. ECG is really time prohibitive, drawing 3ml of blood is relatively quick, and doesn't require specialist training like an ECG does.
- fluoridation 2mo agoYou can still sell snake oil that's purported to improve ECGs.
- sscaryterry 2mo agoWe should talk, if you can't beat 'em, join 'em :)
- fatcatsbestcats 2mo agoThis paper is.. not great. Their clusters and risk model were developed and validated on the same sample. There’s no train/test splitting, no cross-validation anywhere. As a result, all the performance metrics they report for their model are optimistically biased. The comparator models weren’t refit to this sample, either, so the comparison between their model and PREVENT et al. is really an internal validation versus an external validation, which isn’t apples-to-apples and disadvantages the existing models from the get-go. You could say that it’s almost as if their model has a home-field advantage. Because of that fact alone, you can’t really conclude anything about the comparative performance of their models versus the existing ones from this paper.
- er4 2mo agoGet as many scans you can under insurance. Data is king and Claude happens to chew it all pretty well. Apple Health data by itself and family history is enough to make a starter PDF for your cardiologist. Getting an ECG, EKG, TTE, CAC, carotid duplex US, lipid panel, CMP, TSH, 25-OH Vit D, B12 + folate were what my cardio recommended before appointment #2 on hypertension. Both of us are data guys.
- nradov 2mo agoYou don't even necessarily need insurance. Some of those tests you listed are pretty cheap so most people reading this can afford to pay out of pocket even if they're not covered by insurance.
- mvc 2mo agoWhat would an uninsured person do if the tests suggested they needed an medical intervention?
- nradov 2mo agoThat's a pretty broad question. If you could be more specific in terms of the test results, recommended medical intervention, and patient profile (location, age, income, disability status) then I might be able to point you in the right direction.
- rootusrootus 2mo ago> ECG, EKG Those are the same thing, did you mean to type something else?
- nradov 2mo agoThere are lots of different types of heart disease. An ECG can be useful for diagnosing some of them but you're overstating the relative value. For many patients, a CT coronary calcium score or CT angiogram may be more valuable in terms of detecting the type of arterial plaques that might require medical management or major lifestyle modifications in order to prevent a heart attack. These are also non-invasive, although they do involve some radiation exposure. https://www.mayoclinic.org/tests-procedures/heart-scan/about/pac-20384686 https://www.mayoclinic.org/tests-procedures/heart-scan/about... https://www.mayoclinic.org/tests-procedures/ct-coronary-angiogram/about/pac-20385117 https://www.mayoclinic.org/tests-procedures/ct-coronary-angi...
- teleforce 2mo ago>For non-invasive heart disease risk prediction nothing beat ECG, period. Emphasis on non-invasive diagnostic screening as invasive testing like angiogram need to be operated by specialist and can take months to be arranged, and only done after incidents e.g heart attack. ECG is excellent for generic top level CVD anomaly conditions for examples arrhythmia and ischemia.
- nradov 2mo agoCT scans are non-invasive. In most US cities you can schedule one quickly. Screening tests are generally not time critical.
- deleted 2mo ago[deleted]
- teleforce 2mo agoCT scans cannot detect some of CVDs since it mainly cover the vascular vessels part of the CVD not the function of the cardio engine (heart). The test procedure is only recommended if someone has CVD symptoms but not for screening. In most of the countries it will take months to perform the procedures and get the results due the scarcity of the facilities and the severe shortage of the cardiologist to perform the diagnostic with ratio to population of around 1:100,000. ECG is the only one technique that cover comprehensive CVDs screening and it's purely non-invasive (no injection necessary). If someone has blocked arteries or even genetically malform heart like Hypertrophic Cardiomyopathy (HCM) it will show in the ECG traces, that can be cross checked with other relevant CVD diagnostic techniques. The main problem is that the screening GP and even the cardiologist has trouble performing the correct interpretation. This is where advanced signal processing and analytics, ML, AI, etc can really help, but somehow the heart fraternity like AHA is very much still in denial on this matter. Please check the short overview article from Prof. Friedman on ECG based CVD detection in my other comment, ironically commemorating on the 100 years of AHA.
- zhivota 2mo agoI'm not sure how ECG relates, how would ECG predict heart disease risk? I don't see any evidence of that, it's not even mentioned in the article you linked, which is odd considering the whole approach of clustering is gathering as many risk factors and relevant test results as are available.
- teleforce 2mo agoThat's the main contention point, believe it or not current standard for heart diseases risk prediction method do not include the 'elephant in the room' ECG. There are many related research work with excellent results, patent, etc by biomedical researchers around the world that I'd care to mention, including yours truly. Biomedical researchers even has yearly global competition organized so called CINC that used ECG as one of the main input for heart disease risk prediction since it's readily available [1]. In particular check out work by Prof. Friedman on ECG [2]. Somehow his excellent work is mostly being ignored by AHA and their counterparts because apparently these standard risk prediction models in US and Europe are not including it as part of their parameters. [1] Computing in cardiology (CINC): https://cinc.org/ https://cinc.org/ [2] The Electrocardiogram at 100 Years: History and Future: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.123.065489 https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.1...
- PeteZa 1mo agoI expect a CAC (Coronary Artery Calcium Scan) to be better than ECG.