# Deep Survival Analysis from Adult and Pediatric Electrocardiograms: A Multi-center Benchmark Study

arXiv: https://arxiv.org/abs/2406.17002 · HTML: https://mlsanity.com/paper/2406.17002/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 8 of its 41 references that are in the map.
- First posted on arXiv 24 Jun 2024.

## Builds on (most cited first, 8 of 8)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [InceptionTime: Finding AlexNet for Time Series Classification](https://mlsanity.com/paper/1909.04939/) (2019)
- [DeepSurv: Personalized Treatment Recommender System Using A Cox Proportional Hazards Deep Neural Network](https://mlsanity.com/paper/1606.00931/) (2016)
- [Time-to-Event Prediction with Neural Networks and Cox Regression](https://mlsanity.com/paper/1907.00825/) (2019)
- [Automatic diagnosis of the 12-lead ECG using a deep neural network](https://mlsanity.com/paper/1904.01949/) (2019)
- [A Scalable Discrete-Time Survival Model for Neural Networks](https://mlsanity.com/paper/1805.00917/) (2018)
- [Deep neural networks can predict mortality from 12-lead electrocardiogram voltage data](https://mlsanity.com/paper/1904.07032/) (2019)
- [An Efficient Training Algorithm for Kernel Survival Support Vector Machines](https://mlsanity.com/paper/1611.07054/) (2016)

## Abstract (arXiv)

Artificial intelligence applied to electrocardiography (AI-ECG) shows potential for mortality prediction, but heterogeneous approaches and private datasets have limited generalizable insights. To address this, we systematically evaluated model design choices across three large cohorts: Beth Israel Deaconess (MIMIC-IV: n = 795,546 ECGs, United States), Telehealth Network of Minas Gerais (Code-15: n = 345,779, Brazil), and Boston Children's Hospital (BCH: n = 255,379, United States). We evaluated models predicting all-cause mortality, comparing horizon-based classification and deep survival methods with neural architectures including convolutional networks and transformers, benchmarking against demographic-only and gradient boosting baselines. Top models performed well (median concordance: Code-15, 0.83; MIMIC-IV, 0.78; BCH, 0.81). Incorporating age and sex improved performance across all datasets. Classifier-Cox models showed site-dependent sensitivity to horizon choice (median Pearson's R: Code-15, 0.35; MIMIC-IV, -0.71; BCH, 0.37). External validation reduced concordance, and in some cases demographic-only models outperformed externally trained AI-ECG models on Code-15. However, models trained on multi-site data outperformed site-specific models by 5-22%. Findings highlight factors for robust AI-ECG deployment: deep survival methods outperformed horizon-based classifiers, demographic covariates improved predictive performance, classifier-based models required site-specific calibration, and cross-cohort training, even between adult and pediatric cohorts, substantially improved performance. These results emphasize the importance of model type, demographics, and training diversity in developing AI-ECG models reliably applicable across populations.