Identifying Patients for Cardiovascular Evaluation Using Artificial Intelligence and Team-Based Care in Ghana: The H-TRIAGE Study.

Published in Circulation. Population health and outcomes. Abstract: Background: Cardiovascular diagnostic capacity is limited in many low-resource settings. We evaluated the HeartLINK Triage for Risk-Informed Allocation and Guided Evaluation (H-TRIAGE) index, a prespecified strategy combining clinical information and AI-enabled digital auscultation to prioritize cardiovascular evaluation. Methods: In this prospective study in Ghana (February-July 2026), consecutively enrolled adults underwent a standardized assessment by trained frontline nurses and community health workers. H-TRIAGE used predefined additive symptom, vital-sign, and AI-stethoscope weights to assign Low (0-3), Intermediate (4-7), or High (≥8) Risk. Four cardiologists, blinded to H-TRIAGE, independently reviewed all participants; a fifth adjudicated disagreements. The reference standard (adjudicated indication) was a recommendation for further diagnostic testing, cardiologist-led evaluation, or both. The primary cohort comprised 5 facilities across 3 districts of the Ashanti Region; external validation used a held-out facility in a separate district of the Eastern Region. In a modeled allocation analysis, Intermediate- and High-Risk participants were considered prioritized; we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Among 3,800 participants (primary, n=3,123; external validation, n=677; median age, 52 years [IQR, 39-64]; 77.7% women), 1,707 (44.9%) had an adjudicated indication. By H-TRIAGE category, th...