Expert System and Decision Support System for Electrocardiogram Interpretation and Diagnosis: Review, Challenges and Research Directions
, Hammed A. Mojeed 1,2, James A. Ogunmodede 3, Lubna A. Gabralla 4,*, Nasir Faruk 5, Abubakar Abdulkarim 6,7, Emmanuel Ifada 8, Yusuf Y. Folawiyo 9, Abdukareem A. Oloyede 9, Lukman A. Olawoyin 9, Ismaeel A. Sikiru 10, Musa Nehemiah 11, Abdulsalam Ya’u Gital 11 and Haruna Chiroma 12,*
Anatoly Skripal
Round 1
Reviewer 1 Report
The present submission reviews the current expert systems and decision support systems for electrocardiogram interpretation and diagnosis and discusses their challenges and provides the readers with engaging research directions. My suggestions for further improvements to the review paper are as follows:
1- The latest studies for the years 2021 and 2022 should be added to the submission to further make the review comprehensive and attract a wide readership.
2- The current submission requires proofreading, as some incomplete, unclear, and repetitive sentences hinder demonstrating the importance of the work. Please avoid using long paragraphs (more than 7 sentences approximately) in the write-up as they demotivate the reader. I highlighted some concerns about the English language in the file attached.
3- Regarding Table 1, the title of the Table is very general. Please make it more specific like "Reviewing the literature on expert systems and decision support systems for Electrocardiogram Interpretation and Diagnosis". In the Objective and Methodology fields of Table 1, some information is repetitive. Please avoid repetition of information. Moreover, some literature seems to be irrelevant to the study like Hosseini, Tran [95]. Please include only relevant studies in the review. This table also needs reformatting to distinguish different information. Some information in Table 1 is also missing or not sufficiently explained as highlighted in the Table.
4- Please add references to Figures 9 and 10’s titles.
5- Table 2 requires reformatting. Moreover, is any information available for the name or title of apps for highlighted references in the attachment? Some information is also missing in the Table as mentioned in the attached file like VitalSignum Oy (2019). The title of Table 2 could also be considered “The evaluation of mobile applications for ...”.
6- Please briefly mentioned the findings of the studies highlighted in 6.2.3, 7.1, 7.3, 7.4, 7.5, 7.6, 7.7, and 7.8.
7- Regarding Figure 14, it would be best to cite the studies in the Figure rather than using numbers.
8- For Figure 16, please explain it further in the text by answering these questions: What can be understood from it? Which trends are gaining more/less attention? What is the dominant approach all the time?...
9- The authors are encouraged to state the entire phrase before using any abbreviations. Adding an abbreviation section to the paper is also beneficial for readers to refer to.
10- For other corrections, please refer to the attached file.
11- Please highlight the corrections for my comments in the revised file to speed up the review process.
All the best.
Comments for author File: 
Comments.pdf
Author Response
Dear sir,
Attached is the response. Thanks.
Author Response File: Author Response.pdf
Reviewer 2 Report
The review includes historical aspects of the use of ECG for the diagnosis of heart diseases, the connection of ECG diagnostics with other methods of diagnosis of various types of diseases, including cardiovascular diseases.
The review discusses in detail the use of an expert system (ES) and a decision support system (DSS) for ECG interpretation and diagnosis.
The article is undoubtedly useful to specialists in this field.
The review is not without drawbacks.
1. The review has a very large volume, which is partly obtained due to the detailed description of ECG analysis methods, types of Expert System and Decision Support System, the use of mobile ECG applications, which are well known and described in previous reviews. I think sections 3, 4 and 5 can be significantly reduced.
2. Figure 12. presents "Taxonomy of features for ECG interpretation and diagnosis". It is of interest to cite references that use these "features for ECG" methods.
3. Figure 14. presents "Taxonomy of Methods for ES/DSS Development in ECG Interpretation" with an indication of the number of publications on a particular method. It is of interest to give not the number of publications, but to provide links to these publications. This will increase the scientific value of the table, not just its bibliographic value.
4. Section 8. “Challenges and Open Research Issues” does not correspond to modern problems. In section i, the problem is of a social nature rather than a scientific significance. In section ii, the statement of the presence of noise in the signal is not an important problem of ECG interpretation. Section iv mentions the problem of updating the ECG knowledge base in real time.
5. At the same time, the trends presented in Figure 16 "Trend in Publications on ES/DSS based ECG Interpretations" were not reflected in the listed problems.
6. The conclusions largely repeat the annotation. This section should contain conclusions concerning the methods of interpretation and diagnosis of ECG, and not the number of publications reviewed.
7. The highlighted text "This paper further presents" requires correction and does not correspond to the Conclusions section.
Author Response
Dear sir,
Attached is the response. Thanks.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
The current manuscript has improved further, especially after considering the studies from 2021-2022. There are some minor corrections as follows:
1) Please remove Table 1 and add an abbreviation section before the reference section and move the contents of this table to it.
2) The authors are encouraged to proofread again the work as there are some errors. I only highlighted some in the attached file.
3) Reference for Figure 4 is missing.
4) Please insert the name of the app in the second column for Teja and Rao (2018) on page 28 in Table 3.
5) Some of the studies in 6.2.3 and Section 7 and its subsections still require further details about their findings. Please refer to the attached file in the previous review in which I highlighted them to solve this matter.
6) Please improve the quality of Figure 14. The text in it is difficult to read.
7) In Conclusion, please mention that Big Data-Based Methods are recently used and discussed by researchers and explain the reasons behind this trend.
8) Please address some corrections mentioned in the attached file.
Best wishes
Comments for author File: Comments.pdf
Author Response
Attached.
Author Response File: 
Author Response.docx
Reviewer 2 Report
The authors have made the necessary edits to the article. The article is recommended for publication.
Author Response
Attached.
Author Response File: Author Response.docx
