Narrative review of the development of an ischaemic heart disease prognostic scoring tool (i-IHD score) among patients with type 2 diabetes mellitus in Malaysia

ABSTRACT

Introduction: Ischaemic heart disease (IHD) remains a major cause of mortality among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Conventional cardiovascular risk models, such as the Framingham risk score, often show limited calibration in Asian populations. Artificial intelligence (AI)-calibrated models have emerged as potential alternatives, yet their generalisability and clinical utility across different populations remain uncertain. This narrative review aimed to summarise existing prognostic models for IHD in patients with T2DM and identify methodological gaps relevant to the development of a locally calibrated model.
Methods: This narrative review employed a structured search strategy guided by PRISMA principles but was not conducted as a full systematic review. We synthesised evidence from epidemiological and prognostic research. Studies comparing conventional statistical approaches (e.g. logistic regression and Cox models) with AI-calibrated models such as extreme gradient boosting, random forest and support vector machines were reviewed.
Results: Eleven studies met the inclusion criteria; four used conventional statistical methods, and seven applied AI or machine learning algorithms. The reported discrimination (area under the curve=0.66–0.94) varied widely. Conventional models commonly lacked external validation and demonstrated restricted applicability beyond their original cohorts. AI-calibrated models showed promising discrimination in some datasets but similarly experienced limited validation and lacked benchmarking against traditional statistical methods. Across the studies, limited calibration and validation reduced generalisability to heterogeneous Malaysian populations.
Conclusion: Developing a locally AI-calibrated i-IHD score could enable early risk identification, guide targeted interventions and support national health initiatives, including the Health White Paper 2023 and 13th Malaysia Plan.