Differential diagnoses of the heart disease program have better sensitivity than resident physicians.

We describe a prospective clinical evaluation of a computer program to assist with the diagnosis of heart disease. The Heart Disease Program (HDP) is a large diagnostic program covering most areas of heart disease and some related areas of general medicine. The program's output is a set of differential diagnoses with explanations and it can be deployed in a clinical setting using a web interface. A framework for assessing the complex diagnostic summaries generated by the HDP was developed and the program's diagnostic accuracy in a clinical setting was assessed. The diagnoses used for comparison came from the physician entering the case, a "gold standard" assigned by review of patient charts and investigations, and the opinions of expert cardiologists. The data collection, methods of comparison, example analyses and results on 114 cases are presented here. The HDP had a significantly higher sensitivity for both the gold standard (60%) and the cardiologist's diagnoses (58%) than the physicians did (39%, 34%). These findings were consistent in the 2 collection cohorts and for the more serious diagnoses alone. The significance of these findings and the many challenges in comparing these different diagnoses and minimizing bias are discussed.