Computers: the heart of screening

Heart disease is a major killer which often presents as sudden death with no previous history. In most of such cases, the symptoms of the disease are present but are not recognised by the patient or doctor. Screening can identify the individual at high risk, who may then be more closely examined through clinical investigation. The authors have developed and are evaluating an integrated screening system in a general practice in Hertfordshire, UK, based on a general practice database, a health questionnaire and comprehensive clinical investigation using exercise ECG, ambulatory monitoring and blood chemistry. The critical stage is the selection of those at high risk. This requires a decision system that uses the data from questionnaires and that is both sensitive and specific. The authors' current research on neural networks has shown that they possess properties which give excellent results on the subjective, imprecise data that is collected from questionnaires.<>