Perceived Potential and Challenges of Supporting Coronary Artery Disease Treatment Decisions With AI: Qualitative Study

Abstract

Background: Coronary revascularization decision-making for patients with coronary artery disease (CAD) can be complex and challenging. Artificial intelligence (AI) has the potential to improve this decision-making by bringing data-driven insights to the point of care. Objective: We aimed to elicit, collect, and analyze various stakeholders' perceived potential and challenges related to developing, implementing, and adopting AI-based CAD treatment decision support systems. Methods: A facilitated small-group discussion method, known as a World Café, was conducted with general cardiologists, interventional cardiologists, cardiac surgeons, patients, caregivers, health system administrators, and industry representatives. One-on-one interviews were conducted for participants who could not attend the World Café. Perceived potential and challenges of AI-based CAD treatment decision support systems were solicited by asking participants three broad questions: (1) What is most challenging about revascularization decision-making? (2) How could an AI tool be integrated into the existing clinical workflow? (3) What are the critical components that need to be considered when developing the AI tool? Thematic analysis was performed to identify themes from the data. Results: Nine participants completed the World Café, and 3 participants completed the one-on-one interviews. Five main themes emerged: (1) evidence-based care, (2) workload and resources, (3) data requirements (subthemes: patient-centered approach, evidence-based AI, and data integration), (4) tool characteristics (subthemes: end user built; generation and presentation of decision support information; user-friendliness and accessibility; and system logic, reasoning, and data privacy), and (5) incorporation into clinical workflow (subthemes: AI as an opportunity to improve care and knowledge translation). Conclusions: While health care providers aim to provide evidence-based care, CAD treatment decision-making can often be subjective due to the limited applicability of clinical practice guidelines and randomized controlled trial evidence to individual patients. AI-based clinical decision support systems may be an effective solution if the development and implementation focus on the issues identified by end users in this study (patient preference, data privacy, integration with clinical information systems, transparency, and usability).

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