Why the study?
To discuss ethical issues related to the PROFID study, which involves developing a partly artificial intelligence-based prediction model for personalised ICD implantation decision-making in postmyocardial infarction patients and parallel clinical trials testing it.
Complex trials involving AI-based personalized decision-making for ICD implantation raise significant ethical and organizational challenges that require dedicated parallel ethics research and harmonized ethics committee procedures.
AI-ICD trials require integrated ethical oversight before testing; extends frameworks for responsible AI deployment in cardiology.
AIM: To discuss ethical issues related to a complex study (PROFID) involving the development of a new, partly artificial intelligence-based, prediction model to enable personalised decision-making about the implantation of an implantable cardioverter defibrillator (ICD) in postmyocardial infarction patients, and a parallel non-inferiority and superiority trial to test decision-making informed by that model. METHOD: The position expressed in this paper is based on an analysis of the PROFID trials using concepts from high-profile publications in the ethical literature. RESULTS: We identify ethical issues related to the testing of the model in the treatment setting, and to both the superiority and the non-inferiority trial. We underline the need for ethical-empirical studies about these issues, also among patients, as a parallel to the actual trials. The number of ethics committees involved is an organisational, but also an ethical challenge. CONCLUSION: The PROFID trials, and probably other studies of similar scale and complexity, raise questions that deserve dedicated parallel ethics and social science research, but do not constitute a generic obstacle. A harmonisation procedure, comparable to the Voluntary Harmonization Procedure (VHP) for medication trials, could be needed for this type of trials.
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Willems et al. (2021) studied this question.
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