Article Text

Artificial intelligence-based mining of electronic health record data to accelerate the digital transformation of the national cardiovascular ecosystem: design protocol of the CardioMining study
  1. Athanasios Samaras1,
  2. Alexandra Bekiaridou1,2,
  3. Andreas S Papazoglou1,
  4. Dimitrios V Moysidis1,
  5. Grigorios Tsoumakas3,
  6. Panagiotis Bamidis4,
  7. Grigorios Tsigkas5,
  8. George Lazaros6,
  9. George Kassimis1,7,
  10. Nikolaos Fragakis7,
  11. Vassilios Vassilikos8,
  12. Ioannis Zarifis9,
  13. Dimitrios N Tziakas10,
  14. Konstantinos Tsioufis6,
  15. Periklis Davlouros5,
  16. George Giannakoulas1
  17. CardioMining Study Group
    1. 11st Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
    2. 2Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, New York, New York, USA
    3. 3School of Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
    4. 4Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
    5. 5Department of Cardiology, University Hospital of Patras, Rio Patras, Greece
    6. 61st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
    7. 72nd Cardiology Department, Hippokrateion General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
    8. 83rd Cardiology Department, Hippokrateion General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
    9. 9Department of Cardiology, "George Papanikolaou" General Hospital, Thessaloniki, Greece
    10. 10Department of Cardiology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
    1. Correspondence to Dr George Giannakoulas; ggiannakoulas{at}


    Introduction Mining of electronic health record (EHRs) data is increasingly being implemented all over the world but mainly focuses on structured data. The capabilities of artificial intelligence (AI) could reverse the underusage of unstructured EHR data and enhance the quality of medical research and clinical care. This study aims to develop an AI-based model to transform unstructured EHR data into an organised, interpretable dataset and form a national dataset of cardiac patients.

    Methods and analysis CardioMining is a retrospective, multicentre study based on large, longitudinal data obtained from unstructured EHRs of the largest tertiary hospitals in Greece. Demographics, hospital administrative data, medical history, medications, laboratory examinations, imaging reports, therapeutic interventions, in-hospital management and postdischarge instructions will be collected, coupled with structured prognostic data from the National Institute of Health. The target number of included patients is 100 000. Natural language processing techniques will facilitate data mining from the unstructured EHRs. The accuracy of the automated model will be compared with the manual data extraction by study investigators. Machine learning tools will provide data analytics. CardioMining aims to cultivate the digital transformation of the national cardiovascular system and fill the gap in medical recording and big data analysis using validated AI techniques.

    Ethics and dissemination This study will be conducted in keeping with the International Conference on Harmonisation Good Clinical Practice guidelines, the Declaration of Helsinki, the Data Protection Code of the European Data Protection Authority and the European General Data Protection Regulation. The Research Ethics Committee of the Aristotle University of Thessaloniki and Scientific and Ethics Council of the AHEPA University Hospital have approved this study. Study findings will be disseminated through peer-reviewed medical journals and international conferences. International collaborations with other cardiovascular registries will be attempted.

    Trial registration number NCT05176769.

    • Heart failure
    • Ischaemic heart disease
    • Health informatics
    • Risk management

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


    • Twitter @ampekiaridou

    • Collaborators CardioMining Study Group AHEPA University Hospital of Thessaloniki (Greece): Athanasios Feidakis, Anastasios Kartas, Vasiliki Patsiou, Eirinaios Tsiartas, Antonios Orfanidis, Triantafyllia Grantza, Chrysanthi Ioanna Lampropoulou, Dimitrios Kostakakis, Olga Kazarli, Maria Ioannou, Maria Eirini Kiriakideli, Melina Kyriakou, Dimitra Kontopyrgou, Martha Zergioti, Eleftherios Gemousakakis, Amalia Baroutidou, Alexios Vagianos, Alexandros Liatsos, Konstantinos Barmpagiannos, George Tyrikos, George Konstantinou, Anthi Vasilopoulou, Marina Spaho, Eleni Manthou, Panagiotis Zymaris, Eleni Baliafa, Maria Baloka, Iasonas Dermitzakis, Vasiliki Anagnostopoulou, Chrysi Solovou, Anna Maria Louka, Aliki Iliadou, Ioanna Filimidou, Aspasia Kyriafini, Odysseas Kamzolas, Ioannis Vouloagkas, Despoina Nteli, Nikolaos Outountzidis, Athanasia Vathi, Anastasia Foka, Michael Botis, Anastasia Christodoulou, George Vogiatzis, Eleni Vrana, Maria Nteli, Stefanos Antοniadis, Foteini Charisi, Mairifylli Vamvaka, Dimitrios Triantis, Efi Delilampou, Vaggelis Axarloglou, Georgios Charistos, George Anagnostou, Sofia Christodoulou, Anastasios Papanastasiou, Eleni Tziona, Nikolaos Batis, Katerina Gakidi, Artemis Iosifidou, Andreanna Moura, Christos Alexandropoulos, Theoni Exintaveloni, Asterios Karakoutas, Damianos Porfyropoulos, Michail Bountas, Athanasios Pachoumis, Eleftherios Markidis, Maria Sitmalidou, Athanasia Pappa, Konstantinos C Theodoropoulos, George Rampidis, Apostolos Tzikas, Stylianos Paraskevaidis, Georgios Efthimiadis, Antonios Ziakas. University Hospital of Patras (Greece): Theofilatos Athinagoras, Christoforos Travlos, Nikolaos Vythoulkas-Biotis, Kassiani Maria Nastouli, Nikolaos Kartas, Angeliki Vakka, Theoni Theodoropoulou, Maria Bozika, Virginia Anagnostopoulou, Georgios Tsioulos. Hippokration General Hospital of Athens (Greece): Emilia Lazarou, Panagiotis Tsioufis, Ioannis Kachrimanidis, Nick Argyriou. University Hospital of Heraklion (Greece): Emmanouil Kampanieris, Alexandros Patrianakos, George Kochiadakis. Alexandra General Hospital of Athens (Greece): Ioannis Kanakakis. University Hospital of Alexandroupolis (Greece): Marios Vasileios Koutroulos, Georgios K Chalikias. Hippokrateion University Hospital of Thessaloniki (Greece): Sophia Alexiou, Athena Nasoufidou, Panagiotis Stachteas, Constantinos Bakogiannis. University Hospital of Larissa (Greece): Tsantikos Christos, Grigorios Giamouzis, John Skoularigis. Evangelismos General Hospital of Athens (Greece): Ioannis Alexanian. Papageorgiou General Hospital of Thessaloniki (Greece): Dimitrios Farmakis, Ioannis Styliadis. Hellenic Red Cross Hospital of Athens (Greece): George Fotos, Nikolaos Bourboulis. Tzaneio General Hospital of Piraeus (Greece): Despoina Ntiloudi, Evangelos Pisimisis. Hygeia Hospitals Group (Greece) & European Heart Agency, European Society of Cardiology (Belgium): Panos E Vardas. Aristotle University of Thessaloniki (Greece): Antonis Billis, Ilias Kyparissidis. University of Western Macedonia (Greece): Dimitrios Tsalikakis. Beuth University of Applied Sciences (Berlin, Germany): Jens-Michael Papaioannou, Alexander Löser.

    • Contributors Substantial contributions to the conception or design of the work (AS, GG); or the acquisition, analysis or interpretation of data for the work (AS, AB, ASP, DVM, GTso, PB, GTsi, GL, GK, NF, VV, IZ, DNT, KT, PD, GG, CardioMining Study Group); and Drafting the work (AS, AB) or revising it critically for important intellectual content (ASP, DVM, GTso, PB, GTsi, GL, GK, NF, VV, IZ, DNT, KT, PD, GG, CardioMining Study Group); AND Final approval of the version to be published (AS, AB, ASP, DVM, GTso, PB, GTsi, GL, GK, NF, VV, IZ, DNT, KT, PD, GG, CardioMining Study Group); and Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (AS, AB, ASP, DVM, GTso, PB, GTsi, GL, GK, NF, VV, IZ, DNT, KT, PD, GG, CardioMining Study Group).

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.