key: cord-0843443-cb5e2ay7
authors: Haleem, Prof. Abid; Javaid, Dr Mohd; Singh, Dr Ravi Pratap; Suman, Dr Rajiv
title: Applications of Artificial Intelligence (AI) for cardiology during COVID-19 pandemic
date: 2021-04-17
journal: nan
DOI: 10.1016/j.susoc.2021.04.003
sha: 497caa435251fd11abd3d93761a10acae6c865f1
doc_id: 843443
cord_uid: cb5e2ay7

Background and aims Artificial Intelligence (AI) shows extensive capabilities to impact different healthcare areas during the COVID-19 pandemic positively. This paper tries to assess the capabilities of AI in the field of cardiology during the COVID-19 pandemic. This technology is useful to provide advanced technology-based treatment in cardiology as it can help analyse and measure the functioning of the human heart. Methods We have studied a good number of research papers on Artificial Intelligence on cardiology during the COVID-19 pandemic to identify its significant benefits, applications, and future scope. AI uses artificial neuronal networks (ANN) to predict. In cardiology, it is used to predict the survival of a COVID-19 patient from heart failure. Results AI involves complex algorithms for predicting somewhat successful diagnosis and treatments. This technology uses different techniques, such as cognitive computing, deep learning, and machine learning. It is incorporated to make a decision and resolve complex challenges. It can focus on a large number of diseases, their causes, interactions, and prevention during the COVID-19 pandemic. This paper introduces AI-based care and studies its need in the field of cardiology. Finally, eleven major applications of AI in cardiology during the COVID-19 pandemic are identified and discussed. Conclusions Cardiovascular diseases are one of the major causes of death in human beings, and it is increasing for the last few years. Cardiology patients' treatment is expensive, so this technology is introduced to provide a new pathway and visualise cardiac anomalies. AI is used to identify novel drug therapies and improve the efficiency of a physician. It is precise to predict the outcome of the COVID-19 patient from cardiac-based algorithms. Artificial intelligence is becoming a popular feature of various engineering and healthcare sectors, is thought for providing a sustainable treatment platform. During the COVID-19 pandemic, this technology digitally controls some processes of treatments.

Digital technologies are used as monitoring devices to produce a significant amount of data in cardiology. Artificial intelligence (AI) is an intelligent system that can take action in the ongoing COVID-19 pandemic situation. For this, Machine Learning (ML) is required to develop such an intelligent system. This technology can predict and treat complex heart-related problems of the COVID-19 patient. AI used different technologies such as Machine Learning, Natural Language Processing (NLP), Artificial Neural Networks (ANN), Heuristics Analysis (HA), and Support Vector Machines (SVM) [1] [2] [3] . In 1956, the concept of Artificial intelligence was introduced, but its applications expanded in the last few years. It provides development to solve cardiology problems and help us to learn innovative treatments. This technology can be used to keep all records of heart patients for superior outcomes. There are improvements in quality and education through the implementation of AI during the COVID-19 pandemic. Here, it is used efficiently to understand the necessary steps for complex heart surgery. This technology helps decide on a complicated task, as it creates a computerised model to solve different problems without the requirement of human assistance. It continuously learns from the dataset and predicts outcomes accurately than many humans [4] [5] [6] . For cardiovascular disease, AI creates a positive impact on prediction and diagnosis. A physician predicts the readmission of a heart patient from a given electronic health record. AI shows the ability to simulate human intelligence with a computer-based system. It is used for the assessment of congenital heart disease of COVID-19 patients. This technology is helpful to relieve the burden of a cardiologist. It helps monitors the information, alerts the clinicians and patients. Thus, it is used to solve complicated problems by using automated clinical decision systems during the COVID-19 pandemic. It helps doctors to provide an accurate prediction. It provides improvement of the human thought process [7, 8] . The most significant potential is to improve healthcare quality for COVID-19 patients. A cardiologist can digitally check a patient's report without even visiting clinics/hospitals to avoid COVID-19 infection. The patient can take consultation through an app, saving time by reducing unnecessary hospital visits during the COVID-19 pandemic. This technology uses complex algorithms for the analysis of complex medical data. It is integrated into billing, which reduces billing time. The AI applications in cardiovascular medicine are for the clinical investigator, clinician, and computer scientist. It creates continuous development in medicine for reliable and quality health care [9] [10] [11] . Commercial success is being increasingly connected to a commitment to sustainable growth by using artificial intelligence. Various issues are tackled, including climate change and environmental degradation, and that delivering social and environmental well-being through AI is a crucial strategic consideration. Designing out waste and emissions, AI will help businesses to become more resilient to environmental and other threats by streamlining product production and creating responsive and sustainable supply chains. The AI ecosystem, on the other hand, is closely incorporated into the broader open-source community. AI often releases qualified models so that developers can profit from their data and AI knowledge without a sustainable environment. Doctors can quickly identify a heart-related problem. It is used to extend better healthcare to a patient during the COVID-19 pandemic. This technology's applications are to keep records and validate data for effective treatment of the patient [12, 13] . By applying this technology, cardiologist and researcher move towards innovative technological practice during the COVID-19 pandemic. It is now helpful in making precise and accurate information regarding the heart. This technology plays a vital role in cardiovascular medicine by analysing all related records to provide better service to COVID-19 patients.

There is a requirement for accurate assumptions from available heart data of the COVID-19 patient. AI is incorporated into cardiovascular medicine for accurate prediction and outcome. This technology is used to predict congestive heart failure of the COVID-19 patient. AI helps to identify the vital signs regarding heart disease. It is used to identify the disease history and provide proper medication for the treatment. The applications of AI are also for cardiovascular imaging using electronic health records. It has the potential to demonstrate its performance for the medical task to improve diagnosis, prognosis, and efficiency [14, 15] . AI provides a dramatic change in the way doctors practice medicine during the COVID-19 pandemic. It makes a prediction based on available data and evidence-based context. Thus, this technology is also being introduced in cardiology during COVID-19 pandemic due to these various reasons.

It involves smart robots, cloud-based data, soft analysis, smart monitoring, etc., ultimately helping healthcare providers tackle cardiology cases with more impact. Figure 1 reflects the various advanced and well-proven tools and strategies offered while handling the cardiology cases, specifically during the toughest COVID-19 time [16] [17] [18] . Artificial intelligence's philosophy becomes effective when treating smart and intelligent sensors' powerful tools. 

AI improves the relationship between the doctor, surgeon, patient, and administrative staff during the COVID-19 pandemic. The major benefit of this technology is improving work productivity. It reduces the time and cost of complex cardio surgery. This technology is used for the fast prediction of treatment options in care [19] [20] [21] . It is also used to maintain the security of the heart data of the patient. Significant benefits of AI in cardiology, as identified through literature, are as under:

 Daily decision making  Helps surgeon to perform complex task/surgery  Provides proper cardiovascular imaging  Improves efficiency of a heart surgeon  Help perform a precise surgery  Reduces risks of complex treatment  Increases knowledge of cardiologist about the patient behaviour  Provide a better cardiac healthcare solution  Improve patient care even at a distant location  With patient records, useful for computer-aided diagnosis  Improves the teaching and learning process  Helps research and development The focus of this technology is to increase awareness in clinical practice. It reduces cost and increases the value of decision making, interpretation, and image acquisition [15, 16] . With the help of an electronic health record, it provides a better opportunity for personalised therapy.

In the challenging situation of COVID-19, this became a crucial challenge for the cardiologists to offer timely and satisfactory care to their patients. The spread of coronavirus during the several visits of patients to the health centres, i.e. hospitals, medical centres, etc., is the name of a few critical encounters [22] [23] [24] . Figure 2 shows the numerous practical solicitations of artificial intelligence offered to health care providers to fight the issues mentioned above. This also supports the cases like angina issue, fibrillation cases, strokes, etc., which are reported as too challenging to handle with traditional medical care concepts. 

The world is presently suffering from the disastrous impacts of COVID-19 pandemic; this has directly affected the healthcare system and its associated fields. There is a requirement to effectively analyse the large amount of data produced during this global crisis, and AI can do it [25] [26] [27] . AI analyses the raw data and mines the same to derive a meaningful conclusion. Further, it uses various algorithms to analyse the data automatically. We can see that it is useful to monitor the virus and to avoid it from the global spread [28] [29] [30] 7. Artificial Intelligence applications in cardiology during COVID-19 pandemic AI encompasses mathematical algorithms to check human behaviour. It is used to make decisions and perform a task from available data sources for COVID-19 patients. This technology's typical applications are applied to predict outcomes like transcatheter aortic valve implantation and coronary artery stenosis. It can make predictions from lesser assumptions [34] [35] [36] [37] [38] . Table 1 discusses the significant applications of AI in cardiology during COVID-19 pandemic. Analysing heart anatomy of COVID-19 patient  AI is used for automatic analysis of the heart anatomy of a COVID-19 patient for better presentation  Technology is used to improve workflow and perform a time-consuming task in an efficient and consistent manner  For cardio imaging, it introduces algorithms for [39] [40] [41] [42] [43] speeding up the automation  Doctors can accurately analyse heart scans to classify the heart's anatomy  Provides higher capability for the analysis of echocardiograms in a comprehensive way  Analyses cardiac ultrasound from different angles, which can help to identify the diagnostic problem  Quickly identifies congenital heart defects and suggest its better classification 2

Cardiac Magnetic resonance imaging (MRI) ventricle segmentation  AI is helpful for the proper segmentation of cardiac MRI ventricle  In clinical cardiology practice, this technology becomes an essential imaging modality due to its capability for cardiac chambers and great vessels  Helpful in identifying the segmentation of cardiac boundaries to convey appropriate information to the surgeon  Helpful for quantitative evaluations and conduct accurate functional analysis as compared to an existing technique  Proper analysis and measurement of the precise functioning of the cardiovascular system during COVID-19 pandemic  Used for computation of clinical indices like ejection fraction, ventricular volume, and heart valve analysis  Helpful for the automatic evaluation of Heart functioning of COVID-19 patient [47] [48] [49] 3 Detection of arrhythmias of COVID-19 patients  Researchers have used AI to identify the abnormalities in heart rhythm and design improved procedure for better treatment  It is efficient to predict electrocardiogram and examine the irregular heartbeat and risk of death  Scientist and researcher examine and predict the cause for the high-risk COVID-19 patient in future  Reduces risk of heart failure from arrhythmias with proper monitoring of electrocardiogram  Capable of identifying the abnormalities and other related heart problem of COVID-19 patient  Useful to screen a variety of cardiac problem and monitor existing heart diseases [50] [51] [52] [53] 4 Analysis of  AI is used to impact all imaging chain steps of the heart [54] [55] [56] [57] [58] heart imaging of COVID-19 patient of COVID-19 patient  Used for the appropriate selection and analysis of diagnostic heart imaging modality  To identify the best decision support tool for appropriate imaging of a specific COVID-19 patient  For echocardiographic images, AI provides more standardised analysis to reduce dependency  Used to increase the diagnostic performance and sort out various other cardiac-related issues  This technology helps easy carryout of the advanced biomedical research and other medical practice 5

Analysing blood pressure  Used to analyse and monitor the blood pressure of COVID-19 patient with the help of proper information  Detect the amount of blood flowing in and out of the heart  Easily update the status of blood pressure and a variety of all other required information related to heart  Useful to determine the cardiovascular risk by proper analysis of heart image  AI platform is helpful to manage the chronic condition of the patient  Analyse the symptoms of increasing and decreasing blood pressure  Reduces the risk of heart failure, kidney failure, and risk of heart attack [59] [60] [61] [62] [63] [64] 6

Oxygen saturation  AI is appropriately used to analyse the oxygen saturation signal for the betterment of the COVID-19 patient  It develops an intelligent signal for the identification of the relevant diagnostic pattern  Provide individual parameter for the planning and final treatment  Useful to measure the pulse rate and its day by the status of the heart patient  A better demonstration of clinical studies to improve the outcomes of a heart patient during COVID-19 pandemic  Revolutionise to identify the asthma disease and increase the potential of doctors to identify the oxygenrelated problem [65] [66] [67] [68] [69] [70] [71] 7 Heart rate  This technology is used to detect and analyse the heart [72] [73] [74] [75] [76] [77] detection and analysis rate/ breathing rate  Used to detect the problem occurs during congestive heart failure  Appropriately used to analyse the heart rate variability in lesser time  Intelligent ambient sensors are used to create advancement in healthcare during the COVID-19 pandemic  Accurately tracking of heart rate during the workout 8

Predicting heart attack  It helps to predict the chances of a heart attack from previous COVID-19 patient data  During blockage in a heart valve, it aware of heart attack chances  Identify the image pattern of heart attack and accurately predict its occurrence  It embraces the personalised and precise care of heart patient by providing proper information on the heartbeat  By integrating multiple diagnostic data, this technology is used for the simulation of personalised heart [78] [79] [80] [81] [82] 9

Keeping heart data in digital format  AI is used to keep medical record digitally, which can further be used for COVID-19 patient treatments and personalised therapies  It helps to guide the surgeon during treatment, operation, and medication.  Help to track, investigate, detect, and control all information  Used to reduce the manual storing of the data on paper  Presents a massive amount of digital data of the COVID-19 patient which are helpful to provide innovative solution of heart treatment  Analyse the unstructured heart data in the field of cardiovascular research  This digital heart data is used for the research and development field [83] [84] [85] [86] [87] 10 Analysis of blood flow rate  It helps reduction in the risk of sudden cardiac death  AI provides creative ideas to a heart surgeon for the complicated procedure  It can easily understand human language, which enables it to perform a precise treatment  Proper analysis of the blood flow rate is helpful for the [88] [89] [90] [91] [92] [93] [94] [95] diagnosis and treatment of heart disease  Successfully used for computational fluid dynamics to assess the impact of the blockage on blood flow  Eliminating the various testing of any blockage in the heart 11 Providing proper information and medication for COVID-19 patient  The proper information is quickly provided during an emergency case to make the doctor job easy  It suggests proper prescription, protein, medication, and diet plan for the patient  Proper medication to the critical patient using appropriate treatment method, thus making it capable of handling the critical tasks with higher reliability  Allows a cardiologist to solve complex problems with even fewer inputs and tests  It automatically prepares for substantial risks and required actions for the clinical recordkeeping of patients  Checking day to day improvement of the COVID-19 patient  Used along with the contemporary clinical care and clinical decision making [96] [97] [98] [99] [100] [101] AI plays an effective role in managing, monitoring, diagnosing, and improving treatment outcomes of COVID-19 patients [102] [103] [104] . Its use helps make imaging equipment more precise and faster to improve COVID-19 patient satisfaction [105] [106] [107] [108] . It provides guidance, demonstration, and assistance during imaging and evaluation. This technology helps to reduce physician workload [109, 110] . AI technology develops and improves the method of learning. It performed measurement more consistently and faster than human without any interruption [111] [112] [113] [114] . It quickly scans the patient's report to update/remind the patient for an appointment and positively impact human life.

This technology's main benefit is to analyse the collected data that can further be used to improve diagnosis, surgery, and care. It helps to perform planning for COVID-19 patientspecific treatment having congenital heart disease. The major contributions of this study are as under:

 AI provides a positive impact in cardiology during the COVID-19 pandemic by analysing and measuring the functioning of the human heart.  It uses an electric health record, which helps to identify the vital signs regarding heart disease  There are various benefits of AI in cardiology like daily decision-making process, heart imaging, precision in surgery, reduce risk, improve knowledge, patient care, innovative teaching and learning process  The major applications of this technology are analysis of heart anatomy, Cardiac MRI ventricle segmentation, detection of arrhythmias, analysis of heart imaging, analysis of blood pressure, oxygen saturation, heart rate, awareness of heart attack, keep digital heart data, analysis of blood flow rate, proper system information and medication for COVID-19 patient  In the future, this technology is to provide an innovative solution to solve the various problem in cardiology 9. Future scope In the future, AI technology will be readily available and accessible for all. In cardiology, it will provide different technological innovations to faced different issues and challenges. This technology aims to improve the access and monitoring of cardiac activities. Thus, it is used for evaluation, monitoring, and ensuring real-time updates. AI updates all information and makes all decisions for the proper care of the patient. It will answer different complex queries with a lesser presence of doctors. AI-enabled digital health management to generate new insights and possibilities for affordable and scalable care. In future, this technology will be used to prioritise patients based on real-time needs, generate intervention alerts, and recommend follow-up actions. It can also help in creating a personalised plan for individual patients instead of a onesize-fits-all treatment. It will help patients in ensuring drug adherence and monitoring. AI-based machine learning models can help doctors identify patients at risk for heart disease, hypertension, and pre-diabetes. It can also be crucial in preventing the hospitalisation of existing chronic patients. Continuous monitoring of patient vitals and drug adherence can detect the possibility of deteriorating conditions, thus needing hospitalisation.

In cardiology, AI is used to perform a different and specific task during COVID-19 pandemic. It is used to detect abnormal heart rhythms and other defects. With the help of implantable sensors, it easily maintains and monitors the health records of the COVID-19 patient. This technology will not replace doctors, but doctors can efficiently generate hypotheses in cardiovascular medicine daily. It predicts disease and chooses a better option for the treatment of the infected patient. With the input data, this technology improves the performance to achieve a precise result. This requires a large amount of data for better care of the COVID-19 patient. Now doctors can make an errorless decision. It enhanced the training of new doctors effectively and efficiently. AI collects a large amount of patient data, which helps to provide positive changes in cardiology. The time-consuming process of the cardiologist is saved, and the system also achieves an accurate result. AI is used to address environmental problems sustainably. In healthcare, this technology improves communication and various sustainability issues more quickly and efficiently. It provides a personalised educator for the cardiologist to handle the issue of the cardiovascular issue during the COVID-19 pandemic. It reduces manual work involved in the analysis of information and medical recordkeeping during the COVID-19 pandemic. Through the digital information system, it regularly communicates the heart patient and family. AI is now helpful for aortic valve analysis, carina angle measurement, and pulmonary artery diameter. Further, it can be used to capture additional information and proper management of the health system during the COVID-19 pandemic.

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