Artificial Intelligence–Enabled Prediction of Heart Failure Risk From Single-Lead Electrocardiograms
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Abstract
Importance Despite the availability of disease-modifying therapies, scalable strategies for heart failure (HF) risk stratification remain elusive. Portable devices capable of recording single-lead electrocardiograms (ECGs) may enable large-scale community-based risk assessment. Objective To evaluate whether an artificial intelligence (AI) algorithm can predict HF risk from noisy single-lead ECGs. Design, setting, and participants A retrospective cohort study of individuals without HF at baseline was conducted among individuals with conventionally obtained outpatient ECGs in the integrated Yale New Haven Health System (YNHHS) and prospective population-based cohorts of the UK Biobank (UKB) and the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Data analysis was performed from September 2023 to February 2025. Exposure AI-ECG-defined risk of left ventricular systolic dysfunction (LVSD). Main outcomes and measures Among individuals with ECGs, lead I ECGs were isolated and a noise-adapted AI-ECG model (to simulate ECG signals from wearable devices) trained to identify LVSD was deployed. The association of the model probability with new-onset HF, defined as the first HF hospitalization, was evaluated. The discrimination of AI-ECG was compared against 2 risk scores for new-onset HF (Pooled Cohort Equations to Prevent Heart Failure [PCP-HF] and Predicting Risk of Cardiovascular Disease Events [PREVENT] equations) using the Harrel C statistic, integrated discrimination im…
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Recent studies utilising UK Biobank data have demonstrated that AI-powered electrocardiogram analysis can predict heart failure risk from single-lead recordings, showing potential for scalable community-based risk assessment using portable devices.
“Recent studies utilising UK Biobank data have demonstrated how AI-powered electrocardiogram analysis can predict heart failure risk from single-lead recordings, showcasing the potential for scalable community-based risk assessment using portable devices (65).”
From Generative artificial intelligence in predictive analysis of diabetes and its complications: a narrative review (2025) · cites this paper as [65]
Previously, applications of artificial intelligence for electrocardiograms have shown potential to detect signatures of structural heart diseases.
“Previously applications of artificial intelligence for electrocardiograms (AI-ECG) have shown potential to detect signatures of SHDs.10-18”
From Ensemble Deep Learning Algorithm for Structural Heart Disease Screening Using Electrocardiographic Images (2025) · cites this paper as [18]
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Self-citationSEVERE MITRAL STENOSIS AND PULMONARY HYPERTENSION IN PREGNANCY: WHEN TO ACT
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Deep Learning-enabled Detection of Aortic Stenosis from Noisy Single Lead ElectrocardiogramsPreprint
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Self-citationRastogi, T., Ho, F. K. W., Rossignol, P., Merkling, T., Butler, J., Clark, A. L., Collier, T. J., Delles, C., Jukema, J. W., Heymans, S. R. B., et al. (2022) · European Journal of Heart Failure · doi:10.1002/ejhf.2495 · Cited by 12 · see citing works
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Self-citationDhingra, L. S., Aminorroaya, A., Sangha, V., Pedroso, A. F., Asselbergs, F. W., Brant, L. C. C., Barreto, S. M., Ribeiro, A. L. P., Krumholz, H. M., Oikonomou, E. K., et al. (2024) · medRxiv · doi:10.1101/2024.04.02.24305232 · Cited by 9 · see citing works
Self-citationDhingra, L. S., Aminorroaya, A., Sangha, V., Pedroso, A. F., Shankar, S. V., Coppi, A. C., Foppa, M., Brant, L. C. C., Barreto, S. M., Ribeiro, A. L. P., et al. (2024) · medRxiv · doi:10.1101/2024.10.06.24314939 · Cited by 7 · see citing works
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Self-citationPedroso, A. F., & Khera, R. (2025) · npj Cardiovascular Health · doi:10.1038/s44325-025-00071-9 · Cited by 46 · see citing works
Self-citationArtificial Intelligence and ECG: A New Frontier in Cardiac Diagnostics and Prevention
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AHA/ACC/ESC/WHF Expert Consensus Document: Second Universal Definition of Heart Failure (2026)
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Self-citationAHA/ACC/ESC/WHF Expert Consensus Document: Second Universal Definition of Heart Failure (2026)
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Self-citationPredicting Heart Failure From 12-Lead ECGs Using AI
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Artificial Intelligence for Cardiovascular Care in Action
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Self-citationPedroso, A. F., Schwamm, L. H., & Khera, R. (2025) · Stroke · doi:10.1161/strokeaha.125.050447 · Cited by 13 · see citing works
Self-citationKhan, S. S., Bhave, N. M., Blumenthal, R. S., Coresh, J., Huang, X., Joseph, J. J., Khera, A., Ho, J. E., Lloyd‐Jones, D. M., Wang, C. C. L., et al. (2026) · Circulation · doi:10.1161/cir.0000000000001447 · Cited by 10 · see citing works
Precision cardiovascular medicine with big data and AI
Xu, Q., Li, Y., Zhu, M., Cai, Y., Cheng, X., Wan, M., Ju, J., Xu, Y., Li, Y., & Liu, Y. (2026) · npj Digital Medicine · doi:10.1038/s41746-026-02538-0 · Cited by 8 · see citing works
National Patterns of Remote Patient Monitoring Service Availability at US Hospitals
Pedroso, A. F., Lin, Z., Ross, J. S., & Khera, R. (2025) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.125.012034 · Cited by 8 · see citing works
Self-citationCascella, M., Pane, C., Pumpo, M. D., Sebastiani, E., Bussa, M., Tagliaferri, A., Brunetti, B., Meloni, P., Bianchini, E., Graziani, P., et al. (2026) · Infectious Agents and Cancer · doi:10.1186/s13027-026-00737-8 · Cited by 7 · see citing works
Pedroso, A. F., Brant, L. C., Ribeiro, A. L. P., Barreto, S. M., Figueiredo, R. C. C., & Khera, R. (2025) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2025.101392 · Cited by 6 · see citing works
Self-citationNamjouyan, K., Sejdić, E., Link, M. S., Pelliccia, A., Glicksberg, B. N., Trayanova, N. A., & Krittanawong, C. (2025) · Reviews in Cardiovascular Medicine · doi:10.31083/rcm47007 · Cited by 6 · see citing works
Beyond Traditional Screening: The Future of Heart Failure Detection With Biomarkers and AI
Fang, X., Xu, Y., Zhao, Y., Li, L. L., Cheng, Z., Zhang, Z., Luo, Y., Liu, Q., Chen, G., & Shen, S. (2026) · iNew Medicine · doi:10.1002/inm3.70051 · Cited by 6 · see citing works
Butler, J., Khan, M. S., Ferreira, J. P., Girerd, N., Gulati, M., Lala, A., Petrie, M. C., Stockbridge, N., Vaduganathan, M., & Zannad, F. M. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2025.12.029 · Cited by 5 · see citing works
Osonuga, A., Olawade, D. B., Gore, M., Rotifa, O. B., Egbon, E., Chinwah, V., & Boussios, S. (2025) · Annals of Translational Medicine · doi:10.21037/atm-25-62 · Cited by 4 · see citing works
ECGomics: An Open Platform for AI-ECG Digital Biomarker Discovery
Zhang, D., Li, J., Geng, S., Wang, Y., Chen, S., Fan, S., Zhao, Q., & Hong, S. (2026) · Health Data Science · doi:10.34133/hds.0427 · Cited by 4 · see citing works
Multimodal heart failure prediction model based on graph convolutional neural network
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Khan, S. S., Ndumele, C. E., Bhave, N. M., Blumenthal, R. S., Coresh, J., Huang, X., Joseph, J. J., Khera, A., Ho, J. E., Lloyd‐Jones, D. M., et al. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2026.05.007 · Cited by 3 · see citing works
Biswas, D., Aminorroaya, A., Croon, P. M., Batinica, B., Pedroso, A. F., & Khera, R. (2025) · Current Atherosclerosis Reports · doi:10.1007/s11883-025-01337-4 · Cited by 3 · see citing works
Self-citationAdvances in Diagnosis and Treatment of Acute and Chronic Heart Failure: A Comprehensive Review
Kenyon, C. R., Wyk, L. V., Flom, A. P., Ibrahim, R., Pham, H. N., Lakhdar, S., Iftikhar, M., & Abdelnabi, M. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15020618 · Cited by 2 · see citing works
Dhingra, L. S., Croon, P. M., Batinica, B., Aminorroaya, A., Pedroso, A. F., & Khera, R. (2026) · Current Heart Failure Reports · doi:10.1007/s11897-026-00748-x · Cited by 2 · see citing works
Self-citationDevelopment and Validation of the AI-HeartAge Model in Framingham and UK Biobank
Korzinski, T. J., Prescott, B. R., Hamel‐Sellman, D. J., Xanthakis, V., Cooper, L. L., Hamburg, N. M., Tsao, C. W., Benjamin, E. J., Vasan, R. S., & Mitchell, G. F. (2026) · Hypertension · doi:10.1161/hypertensionaha.125.26209 · Cited by 2 · see citing works
Wearable-Echo-FM: an ECG echo foundation model for 1-lead electrocardiography
Knight, E., Oikonomou, E. K., Aminorroaya, A., Pedroso, A. R., & Khera, R. (2026) · European Heart Journal - Digital Health · doi:10.1093/ehjdh/ztag049 · Cited by 2 · see citing works
Self-citationWearable Devices and Data Sharing in the US
Pedroso, A. F., Dhingra, L. S., Aminorroaya, A., & Khera, R. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.17733 · Cited by 2 · see citing works
Self-citationArtificial Intelligence Electrocardiogram Risk Tool—Reply
Dhingra, L. S., Aminorroaya, A., & Khera, R. (2025) · JAMA Cardiology · doi:10.1001/jamacardio.2025.4246 · Cited by 1 · see citing works
Self-citationOkada, J., Fujiu, K., Hasumi, E., Chen, Y., Washio, T., Hisada, T., & Sugiura, S. (2026) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2026.109247 · Cited by 1 · see citing works
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Węgrzyn‐Witek, A., Przewłocka‐Kosmala, M., Kosmala, W., & Marwick, T. H. (2025) · ESC Heart Failure · doi:10.1002/ehf2.15442 · Cited by 1 · see citing works
Artificial intelligence in heart failure
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Croon, P. M., Dhingra, L. S., Pedroso, A. F., & Khera, R. (2026) · Current Heart Failure Reports · doi:10.1007/s11897-026-00764-x · Cited by 1 · see citing works
Self-citationChoi, R. B., & Khera, R. (2026) · European Heart Journal - Digital Health · doi:10.1093/ehjdh/ztag091 · Cited by 1 · see citing works
Self-citationComments: Heart failure monitoring with a single‑lead electrocardiogram at home
Yadav, A., Yadav, O., Gupta, N., & Gupta, R. (2025) · International Journal of Cardiology · doi:10.1016/j.ijcard.2025.133659 · Cited by 1 · see citing works
The Emerging Role of ECG-AI as a Digital Risk Biomarker for Incident Heart Failure
Oikonomou, E. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2025.11.039 · Cited by 1 · see citing works
Self-citationPan, L., Li, S., Huo, J., Xiao, Z., Yu, Z., Chen, J., Zhou, Y., Li, Z., Zhang, B., Li, X., et al. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.6757316 · Cited by 1 · see citing works
Machine Learning in Cardio-Oncology: Innovation or Overhype?
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Artificial Intelligence Electrocardiogram Risk Tool
Yadav, A., Samineni, L. N., & Gupta, R. (2025) · JAMA Cardiology · doi:10.1001/jamacardio.2025.4243
Blaiech, F. H., Hattay, J., & Machhout, M. (2026) · Research Square · doi:10.21203/rs.3.rs-8608402/v1
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Artificial intelligence in early heart failure detection: from algorithms to bedside integration
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Contemporary Diagnosis of Heart Failure: Integrating Traditional Tools and Emerging Biomarkers
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Emerging Artificial Intelligence Tools for the Screening of Structural and Valvular Heart Disease
Abbaoui, Y., Nolin-Lapalme, A., Morisset, J., Adib, I. E., Généreux, P., Poterucha, T. J., Elias, P. A., Yao, X., & Avram, R. (2026) · Current Heart Failure Reports · doi:10.1007/s11897-026-00757-w
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AI in cardiovascular disease classification—a systematic literature review
Karandikar, M., Sawant, S., Kumbhar, S., & Bidwe, R. V. (2026) · Artificial Intelligence Review · doi:10.1007/s10462-026-11592-9
Mapping the research landscape of artificial intelligence in heart failure: a bibliometric analysis
Rashidian, P., Jala, S. R. A., Somu, K. P., Mahapatro, A., Chellapuram, N., Hashemi, S. M., Alotaibi, A. J., Hasan, O. H., Nasrollahizadeh, A., Letafatkar, N., et al. (2026) · Annals of Medicine and Surgery · doi:10.1097/ms9.0000000000005235
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Artificial Intelligence in Cardiology: Applications in Diagnosis and Risk Prediction
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Recalibrating Risk: A Call for South Asian-Focused Heart Failure Prediction Models
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ECG-based longitudinal risk prediction across diseases and organ systemsPreprint
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Reading between the waves: what does AI-ECG capture when estimating NT-proBNP?
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The PREVENT equations evidence appraisal of validation and clinical implications
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Advances in Artificial Intelligence-based Cardiovascular Disease Prevention and Assessment
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Artificial intelligence in cardiovascular imaging and electrocardiography
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- Authors
- Dhingra, L. S., Aminorroaya, A., Pedroso, A. F., Khunte, A., Sangha, V., McIntyre, D., Chow, C. K., Asselbergs, F. W., Brant, L. C. C., Barreto, S. M., Ribeiro, A. L. P., Krumholz, H. M., Oikonomou, E. K., & Khera, R.
- Affiliations
- Yale University (US)
- The University of Sydney (AU)
- National Institute for Health and Care Research (GB)
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais (BR)
- Yale New Haven Hospital (US)
- Corresponding author
- Khera, Rohan
- ORCID
- Venue
- JAMA Cardiology
- Publisher
- American Medical Association (AMA)
- Published
- 2025-06-01
- Volume
- 10
- Issue
- 6
- Pages
- 574
- ISSN
- 2380-6583 (ISSN-L)
- PMC
- PMC11160804
- OpenAlex
- W4409502323
- Cited by
- 65
- References
- 83
- Citations by year
- 2026: 45 · 2025: 20
- FWCI
- 45.41
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- cc-by-nc
- Locations
- JAMA Cardiology (publishedVersion)
- medRxiv (acceptedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- PubMed Central (submittedVersion, cc-by-nc)
- UCL Discovery (University College London) (submittedVersion)
- PubMed Central (submittedVersion)
- Funders
- National Institutes of Health (1r01ag089981-01)
- National Heart, Lung, and Blood Institute (F32HL170592, R01HL167858, K23HL153775)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- heart failure prediction, single-lead ECG, artificial intelligence, wearable devices, left ventricular systolic dysfunction, new-onset heart failure, risk stratification, community-based risk assessment, UK Biobank, ELSA-Brasil
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