Predicting 1-year outcome following acute myocardial infarction: physicians versus computers

Whether decision rules derived statistically from patient data can produce better decisions than an expert clinician or a model of the expert clinician (expert system) is controversial. We examined this issue in the context of predicting cardiac death by 1 year for patients discharged from the hospital following acute myocardial infarction. Decision rules were derived from a base sample of 781 patients. These decision rules and three experienced cardiologists then estimated probability of death by 1 year for each patient in a separate test sample (n = 400). In our evaluation of the performance of the decision rules and physicians, we detected no differences, although the decision rules and physicians tended to classify the patients somewhat differently. Further multivariate analyses on the physicians' predictions showed that two of the physicians paid attention to somewhat different variables than the third physician. Lack of agreement among expert cardiologists would complicate modeling of a consensual decision-making process within the framework of an expert system.