By Dr. Payal Kohli, MD, FACC
The way we currently conduct clinical research can be expensive and energy-intensive. We ask a research question, and then we spend hundreds of thousands of dollars trying to set up a clinical trial to answer that question. The process involves organizing and training the sites, collecting generated data for review, and analyzing the data.
Meanwhile, the answers to many of the research questions we are posing might be in front of our eyes. The advent of electronic medical records and cloud-based information storage has made ECG database mining a possibility, and a wealth of ECGs is standing by to answer clinical questions that have yet to be asked.
Data Mining Multiplies the Power of ECG
ECGs are some of the simplest tests conducted in the healthcare setting, and they can provide substantial information. ECGs not only include information about acute-care situations, such as myocardial infarction; they can also show subtle cardiac changes that may be the earliest manifestation of adverse cardiac remodeling, such as left ventricular hypertrophy. In addition, ECG can contain clues about hidden genetic diagnoses, such as hypertrophic cardiomyopathy.
If a single ECG can yield powerful insights, then a consolidated database of millions of annual ECGs on a standardized reporting platform could provide a rich source of information for researchers aiming to leverage data mining.
A Journal of Applied Research Review (JARR) article defines data mining as the analysis of observational data sets to derive relationships or extract hidden trends. This approach is especially applicable to ECG analysis for three key reasons:
- Unlike other electronic medical records, ECGs are standardized, always obtained in the same format, and always reported in the same way. These qualities make them amenable to artificial intelligence analysis and computerized algorithm review.
- ECGs can be readily stored in a cloud-based or centralized database in large quantities.
- As the JARR review notes, there are numerous validated and well-studied ECG data mining algorithms that can review and analyze thousands of ECGs in seconds.
In aggregate, these advantages create the perfect recipe for the application of data mining, a technique that has the potential to reveal trends and insights quickly and accurately.
To learn more about the power of the ECG in today's clinical landscape, browse our Diagnostic ECG Clinical Insights Center.
The Trials of Tomorrow
The research designs of yesterday, which primarily involved expensive, outcomes-based, randomized clinical trials can now give way to new methodologies that employ existing databases to obtain novel insights.
The Wall Street Journal reported that Pfizer Inc., Johnson & Johnson, and Amgen Inc. sought drug approvals via data-mining methods, which proved faster and more cost-effective than traditional approaches. A study in the Annals of Clinical and Laboratory Research on improving clinical trials in diabetic patients through data mining concluded that if the methodology is more widely adopted by researchers, "it will be much easier to collect, evaluate and analyze data and improve the quality of clinical trials all over the world."
Implications for the COVID-19 Pandemic
2020 has sped up the scientific process on many fronts. For example, while the development process for a vaccine would normally take 10 to 15 years, the COVID-19 vaccine was created in under a year. We have also studied and applied older therapies, such as dexamethasone, to treat COVID-19 patients and used novel physiologic tactics, such as proning of patients, to improve the COVID-19 case fatality rate within the span of a few short months.
The current landscape of accelerated clinical research provides an opportunity to consider how we can use data mining and ECG databases to identify patterns that could answer critical questions about the ECG characteristics and clinical implications of COVID-19.
An ECG database of COVID-19 patient scans taken during and after recovery could reveal trends hidden within ECGs that may help us understand and combat the virus at scale. In the meantime, ECG remains a tool of considerable diagnostic and prognostic value for managing COVID-19 at the patient level.
Dr. Payal Kohli, MD, FACC is a top graduate of MIT and Harvard Medical School (magna cum laude) and, as a practicing noninvasive cardiologist, is the managing partner of Cherry Creek Heart in Denver, Colorado.
The opinions, beliefs and viewpoints expressed in this article are solely those of the author and do not necessarily reflect the opinions, beliefs and viewpoints of GE Healthcare. The author is a paid consultant for GE Healthcare and was compensated for creation of this article.