Artificial intelligence for the management of multimorbidity in AF patients: the ARISTOTELES project

Atrial fibrillation (AF) is the most common arrhythmia worldwide and is frequently accompanied by comorbidities such as heart failure, diabetes, kidney disease, and hypertension. These conditions complicate clinical management, increase the risk of adverse outcomes, and are often not adequately addressed by current guidelines. Artificial intelligence (AI) has recently emerged as a promising tool in medicine, offering new opportunities for prediction and decision support. However, its role in managing multimorbidity in AF remains largely unexplored.

Design: The ARISTOTELES project brings together 18 academic institutions across 10 countries to evaluate the potential of AI in improving the management of AF in multimorbid patients. The project is organized into eight interconnected work packages over five years. At its core is the development of a large, multinational data platform that integrates clinical records, imaging, biomarkers, and genetic data from real-world sources. This harmonized dataset will be used to train advanced AI models for personalized risk stratification and outcome prediction.

The patients’ perspective will be actively considered throughout the ARISTOTELES project. Patients will be engaged in the design and implementation process to ensure that the developed AI tools are clinically relevant, user-friendly, and aligned with real-world needs. The AI models will first undergo in silico validation, followed by testing in a large, cluster-randomized controlled trial involving more than 1000 AF patients in four European countries (Italy, Spain, Romania, and Greece). In this two-arm trial, clinical sites will be randomized to either AI-informed patient management or standard care, with outcomes compared over a minimum follow-up of one year.

ARISTOTELES aims to integrate AI-based tool into clinical practice for AF management, facilitating personalized care strategies and optimizing the use of healthcare resources across Europe. The project is expected to improve outcomes for patients with AF and multimorbidity, ultimately benefiting both individuals and healthcare systems.