Health Care Professionals and Data Scientists’ Perspectives on a Machine Learning System to Anticipate and Manage the Risk of Decompensation From Patients With Heart Failure: Qualitative Interview Study
Authors: Seringa Joana , Hirata Anna , Pedro Ana Rita , Santana Rui , Magalhães Teresa 
Published: January 2025

Background
Heart failure (HF) is a significant global health problem, affecting approximately 64.34 million people worldwide. The worsening of HF, also known as HF decompensation, is a major factor behind hospitalizations, contributing to substantial health care costs related to this condition.

Objective
This study aimed to explore the perspectives of health care professionals and data scientists regarding the relevance, challenges, and potential benefits of using machine learning (ML) models to predict decompensation from patients with HF.

Methods
A total of 13 individual, semistructured, qualitative interviews were conducted in Portugal between October 31, 2022, and June 23, 2023. Participants represented different health care specialties and were selected from different contexts and regions of the country to ensure a comprehensive understanding of the topic. Data saturation was determined as the point at which no new themes emerged from participants’ perspectives, ensuring a sufficient sample size for analysis. The interviews were audio recorded, transcribed, and analyzed using MAXQDA (VERBI Software GmbH) through a reflexive thematic analysis. Two researchers (JS and AH) coded the interviews to ensure the consistency of the codes. Ethical approval was granted by the NOVA National School of Public Health ethics committee (CEENSP 14/2022), and informed consent was obtained from all participants.

Results
The participants recognized the potential benefits of ML models for early detection, risk stratification, and personalized care of patients with HF. The importance of selecting appropriate variables for model development, such as rapid weight gain and symptoms, was emphasized. The use of wearables for recording vital signs was considered necessary, although challenges related to adoption among older patients were identified. Risk stratification emerged as a crucial aspect, with the model needing to identify patients at high-, medium-, and low-risk levels. Participants emphasized the need for a response model involving health care professionals to validate ML-generated alerts and determine appropriate interventions.

Conclusions
The study’s findings highlight ML models’ potential benefits and challenges for predicting HF decompensation. The relevance of ML models for improving patient outcomes, reducing health care costs, and promoting patient engagement in disease management is highlighted. Adequate variable selection, risk stratification, and response models were identified as essential components for the effective implementation of ML models in health care. In addition, the study identified technical, regulatory and ethical, and adoption and acceptance challenges that need to be overcome for the successful integration of ML models into clinical workflows. Interpretation of the findings suggests that future research should focus on more extensive and diverse samples, incorporate the patient perspective, and explore the impact of ML models on patient outcomes and personalized care in HF management. Incorporation of this study’s findings into practice is expected to contribute to developing and implementing ML-based predictive models that positively impact HF management.