A Novel Deep Ensemble Method for Selective Classification of Electrocardiograms

Objective: Telehealth paradigms are essential for remotely managing patients with chronic conditions. To assist clinicians in handling the large volumes of data collected through these systems, clinical decision support systems (CDSSs) have been developed. However, the effectiveness of CDSSs depends on the quality of remotely recorded physiological data and the reliability of the algorithms used for processing this data. This study aims to reliably detect atrial fibrillation (AF) from short-term single-lead (STSL) electrocardiogram (ECG) recordings obtained in unsupervised telehealth environments. Methods: A novel deep ensemble-based method was developed for detecting AF from STSL ECG recordings. Following this, a postprocessing algorithm was created to assess uncertainty in classified STSL ECGs and to refrain from interpretation when confidence is low. The proposed method was validated through a 5-fold cross-validation on the Cardiology Challenge 2017 (CinC2017) dataset. Results: The deep ensemble method achieved 83.5 ± 1.5% sensitivity, 98.4 ± 0.2% specificity, and an F1-score of 0.847 ± 0.016in AF detection. Implementing the selective classification algorithm resulted in significant improvements, with sensitivity increasing to 92.8 ± 2.2%, specificity to 99.7 ± 0.0%, and an F1-score of 0.919 ± 0.016. Conclusion: The proposed method demonstrates the feasibility of accurately detecting AF from STSL ECG recordings. The selective classification approach offers a substantial enhancement to automated ECG interpretation algorithms in telehealth solutions. Significance: These findings highlight the potential for improving the utility of telehealth systems by integrating advanced CDSSs capable of managing uncertainty and ensuring higher accuracy, thereby improving patient outcomes in remote healthcare settings.