Cognitive Assessments
The rise of artificial intelligence (AI) is transforming the future of medicine and healthcare. Naturally, a central theme at the 2025 European Society of Cardiology (ESC) Congress in Madrid was how AI, machine learning, and digital health technologies are reshaping the future of cardiology.
As the field begins to embrace these innovations, conversations are shifting from initial excitement over their promise towards practical questions of how to integrate them into clinical practice while addressing challenges, such as validation requirements and regulatory hurdles.
Emerging Trends
Improved Risk Prediction
AI is increasingly applied to integrate imaging results with broader clinical data, resulting in more precise risk stratification and event prediction, as evidenced by the results of the PECTUS-AI trial and CONFIRM2 registry.1,2
In both cohorts, AI-based analysis of coronary imaging outperformed traditional evaluations in predicting major adverse cardiovascular events. Traditionally, clinicians assess artery narrowing visually via coronary computed tomography (CT) angiography, while AI quantifies total plaque volume, noncalcified plaque, and high-risk morphologies, such as low-attenuation plaque, allowing for more accurate predictions.
These studies demonstrate the potential of AI to standardize risk stratification. However, speakers also highlighted the need for validation by directly linking AI applications to real-world clinical outcomes.
Precision Interventions
Digital innovations, including robotic assistance, virtual reality (VR), and digital twins, are enhancing procedural precision and improving patient outcomes:
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Robotics-based systems, such as the Bed Based Echo (BBE) platform by Corbotics, are being developed to automate echocardiography, aiming to alleviate sonographers’ workload and standardize image acquisition. Robotic platforms also enable clinicians to perform remote procedures, improving access in underserved areas.
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VR offers benefits for both medical professionals and patients. Patient CT/magnetic resonance imaging data can be converted into interactive VR 3D heart models for training and pre-procedural planning by clinicians. For patients, VR headsets can be used to deliver distraction therapy during minimally sedated procedures. Immersive calming environments divert attention from clinical stressors, thereby reducing anxiety in patients undergoing cardiac interventions.3
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Digital twins, a virtual replication of an individual that integrates anatomical, mechanical, electrophysiological, and hemodynamic data, allows clinicians to simulate clinical scenarios and forecast individual outcomes.4
However, despite the promise of these applications, significant gaps remain before widespread adoption. Access may remain limited for underserved populations with poor healthcare infrastructure, raising concerns about technological equity.
Additionally, algorithmic biases in AI models trained on unrepresentative datasets or under-represented populations could disadvantage diverse patient anatomies. Therefore, well-designed clinical trials are needed to confirm real-world performance, usability, and effectiveness across diverse patient populations.
Empowering Patients with Heart Disease
Wearable devices and smartphones are emerging as key tools for screening and remote patient monitoring:
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Smartwatches may be used to detect possible atrial fibrillation (AF), as has been demonstrated in the Apple Heart Study. Ongoing research, such as the Johnson & Johnson Heartline Study5, evaluates whether the combination of an Apple Watch with an iPhone app for patient education may improve AF detection, diagnosis, and cardiovascular outcomes.
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Wearable technology also enables remote monitoring of patients. These devices, including smartwatches, rings, and glasses, support home-based monitoring through continuous tracking of heart rate and/or rhythm, physical activity, and sleep. In heart failure patients, wearables have been used to detect clinical deterioration, allowing earlier intervention and potentially reducing hospitalizations.
However, ESC sessions highlighted challenges that limit widespread adoption, such as excessive screen time, regulatory adaptation needs, user adherence issues, and accessibility barriers for less tech-savvy or underprivileged populations.
Additionally, while consumer-grade wearables may have valuable roles in screening and monitoring, they have inherent accuracy limitations compared to research-grade devices when measuring physiological parameters (e.g., heart rhythm), indicating they complement rather than replace formal clinical diagnostics.
Conclusion and Outlook
As highlighted throughout ESC 2025, AI and digital innovations are here to stay. Their integration holds real promise for more precise, personalized cardiac care. However, successful use in practice requires well thought-out regulatory frameworks, publicly accessible data and software for independent verification, standardized data formats across healthcare systems, and rigorous clinical testing and validation through randomized controlled trials with adequate sample sizes and diverse, representative populations.
It is essential that cardiologists, researchers, regulators, and patients work together to balance these technologies with human expertise – and not replace it – while maintaining high scientific and ethical standards.
About the authors
Maria Visser, PhD is a Clinical Scientist at Signant Health, specializing in Phase 3-4 dermatology clinical trials, with a focus on atopic dermatitis, pruritis, and vitiligo. With a Ph.D. in Physiological Sciences and a background in clinical research, Maria leverages their analytical and critical thinking skills to solve complex problems. Known for their effective interpersonal communication, they engage seamlessly with both internal and external stakeholders.
Vanessa Louw is a Clinical Specialist at Signant Health, where she supports clinical studies across a range of therapeutic areas. She holds an M.Sc. in Pharmacology and has a background in analytical research and clinical trials. Vanessa brings technical expertise, attention to detail, and collaborative energy to her partnerships with internal teams and study sponsors.
