AI models predicting Risk of Cardio Vascular Diseases - The Limitations, Challenges and Necessity for Regulatory Framework

Abstract

Artificial intelligence (AI) algorithms have changed the landscape of Cardio Vascular Disease (CVD) risk assessment and demonstrated a better performance mainly due to its ability to handle the input nonlinear variations. Further, it has the flexibility to add risk factors derived from medical imaging modalities using Computer Vision (CV). Most commonly used algorithms in CVD risk predications were classification and regression tress (CART).
 Though most of the developed models have shown good accuracy but have not considered risks factors or dependent variables related to specific population which plays an integral role in predicting the risk of CVDs. This Include gender specific clinical risk factors (hormonal changes, bone density etc.), metrological, chronological data, exposure to environmental pollutants, race, genotype, hereditary, dietary intake, physical inactivity, psychological stress etc. Secondly the existing models have not included the weighing and grading of the risks, as all factors won’t contribute equally to the Cardiac Risk. Importantly predictive models can be readily used within the populations in which they were developed but practically they often give a less than satisfactory performance, when applied to another population because of the Inter genetic variations especially in CVDs.
 India accounts for one-fifth of these deaths worldwide especially in younger population. The results of Global Burden of Disease study state age-standardized CVD death rate of 272 per 100000 populations in India, which is much higher than that of global average of 225. CVDs strike Indians a decade earlier than the western population. For Indians, particular causes of concern in CVD are early age of onset, rapid progression and high mortality rate. Indians are known to have the highest coronary artery disease (CAD) rates, and the conventional risk factors fail to explain this increased risk.
 In Indian context, aggressive screening tests should begin at an early age and will be beneficial for early detection and treatment to reduce the mortality. Hence there is necessity to develop upgraded AI models specific to a subset of population (Indian, Caucasoid, Dravidian etc.) inclusive of the risk factors in that specific population. Secondly allotting weighing, grading of risk factors in the model will provide accurate cardiac risk prediction compared to other approaches.
 The regulatory and policy landscape for AI is an emerging issue in jurisdictions globally, including in the European Union and in supra-national bodies like the IEEE, OECD and others. Since 2016, a wave of AI ethics guidelines has been published in order to maintain social control over the technology.