Development of an AI-Based Clinical Decision Support System to Predict and Simulate Exercise-Driven Functional Improvement in Cardiac Rehabilitation

Abstract

Cardiac rehabilitation (CR) improves functional capacity and reduces cardiovascular morbidity, yet clinical response remains highly heterogeneous and difficult to stratify using conventional assessment. This study presents a machine-learning framework for the early stratification of CR patients into responders and non-responders based exclusively on pre-intervention baseline characteristics. A total of 122 patients undergoing an 8-week CR program were evaluated using 56 clinical, physiological and metabolic predictors. Multiple classification models were trained under a stratified 10-fold cross-validation scheme. Among them, an SVM-RBF classifier achieved the best performance and retained high discriminative capacity after dimensionality reduction. The final reduced model, based on the ten most informative features identified through convergence between Random Forest and SHAP analyses, preserved >95% of the full-feature performance. The predictors were physiologically coherent, reflecting muscular strength, ventilatory efficiency, chronotropic modulation and metabolic burden. SHAP-based explainability enabled patient-level attribution of improvement likelihood, identifying modifiable variables associated with favorable or limited training response. In parallel, we developed a web-based clinical decision-support prototype that estimates improvement probability and highlights the most influential determinants for each patient, illustrating translational applicability for precision rehabilitation planning. These findings support a transition toward personalized CR strategies guided by explainable AI and baseline phenotyping.